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UI AK U, tED PROGRAM CONSOLIDATED FOR UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION -TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1.U,Ill.!I',and Lt"below) 43° .SI/l� C11.NEW PERMIT C33.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION 1 1/ 1 ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID h(Agency Use Only) _ _ 3 5 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 Tesoro/Shell 68153 BUSINESS SITE ADDRESS 107 1 CITY 104 2448 W. Kettleman Lane Lodi H. TANK DESCRIPTION TANK ID 4 �f 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 I ® 1.A STAND-ALONE TANK Complete one page for each ti 11�� Owens Corning ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit DATE UST SYSTEM INSTALLED ij5 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1989 10,000 l III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25281 5(c)] _ ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN _ ❑ 99.OTHER(Specify): 439a CONTENTS PETROLEUM: LAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 3.DIES ❑ 5.JET FUEL ❑ 6.AVIATION GAS __EUM BLEND FUEL ❑_9.OTHER PETROLEUM(Specify): 440a NON-PETROLEUM ❑ 7.USED OIL ❑ 10.ETHANOL ❑ 1 I.OTHER NON-PETROLEUM(Specify): 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ L STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a SECONDARY CONTAINMENT -❑ I.STEEL ®3 FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify_)_: 445x. OVERFILL PREVENTION ❑ I AUDIBLE&VISUAL ALARMS ❑ 2 BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460 SYSTEM TYPE_ --_®-i PRESSURE C--12,-.,GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ t SAFE SUCTION j23 CCR 82636(aN31] 458 PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ &FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑_99.OTHER(Specify): SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC a64b _ ❑ 90.NONE _❑ 95.UNKNOWN ❑ 99.OTHER( ify) 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT'PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS [310.RIGID PLASTIC E390.NONE [399.OTHER(Specify): 46 e1 VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46M VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4464 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [399.OTHER(Specify): 64hI � - 464h _ VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE aha RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS (-I10.RIGID PLASTIC ❑ 90.NONE [399.OTHER(Specify) 4641 RISER SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS EI10.RIGID PLASTIC ® 90.NONE E3 OTHER(Specify): 464kkl FILL COMP_ONENTS INSTALLED ® 1.SPILL BUCKET - ff STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45la-c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE CONSTRUCTION MATERIAL ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specdy) m VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 'a IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this [QST system is compatible with the hazardous substance stored and that the information provided herei true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 4/14/2011 APPLICANT NAME(print) Sandy Edi ards 471 APPLICANT TITLE Environmental Compliance 472 UPCF UST-B Rev.(12/2007)- 1/2 www.unidocs org