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May 1109 03:47p MVP Petroleum Engineering 916-984-1117 p.4 • -b'lU � L UNIFIED PROGRANI CONSOLIDATED FORM �� I`r n UNDERGROUND STORAGE TANK ` /2v OPERATING PERINUT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check are item only_ For a W closure or remora4 complete only this section and Seciians I.IL IIP.IV and Lt'below) 430. ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT S.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE Pf S.LEST REMOVAL DATE UST PERMANENTLY CLOSED: 4300.1 DATE EXISTING UST DISCOVERED: 43ob. I. FACILITY I FORNVLATION FACILITY ID P(Agency Use On7)d - I - 1 BUSINESS NAME(Same as Fact iry Nome or DBA-Doing Business As) i J. E)Cpa-e-s-. BUSINESS SITE ADDRESS IU3• CITY Ie.. S5 s7 II. TANK DESCRTiPTION TANK/Dn 4-2 TANK MANUFACTURER 433, TANK CONFIGURATIONI:THIS TANK ISIV2 J31, Ib Z t ] ! ro � - 1_A STAND-ALONS TANK Compleeme nnye formdh L/1j (e-"pr� r 2.ONE IN A COMPARTME -rED LINT ammmumm in dre unit. DATE USTSYSTEM INSTALLED 135 TANK CAPACITY IN GALLONS 436. NUNIBER OF COMPARTMENTS IN THE UNIT 437" tj le- 1 0 III. ANK USE AND CONTENTS TANK USE � la.MOTOR VE-RCLE FUELING ❑ Ib.aARINA FUELING ❑ Ic.A11L4TTON FUELING 439, 3,CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ineudcs Used on) ❑S.EMERGENCY GENERATOR FUEL IaSC§25281.5(c)l _ _ __❑ 6_OTNER GENERATOR FUEL_ ❑ 95.U_Nhiy_Ot1T _ _ _ _ _ _ _ 1199.OTHER(Specify): 4394. CONTENTS PETROLEUM: -❑ Ea.REGULAR UNLEADED - QTc NltDGRADE UNLGDLD ib.PRE>ifUM UNL LADED 440 ❑ 3.DIESEL ❑ i.JET FUEL 6.AVIATION GAS ___._.------......---_-..............-...-_--_-0 8-PFTROLEUM BLE(%1D FUEL ❑ 9.OTHER PETROLEUM(S(x¢ifyr 4400 NON•PETROLEUM:❑ 7-USED OIL ❑ METHANOL ❑ 11.OTHER NOA'-PETROLEUNI(Sped i r 4406, IV. TAINT{CONSTRUCTION TYPE OF TANK 1.SINGLEWALL Z DOUBLE WALL ❑ 95.UN<NOtt\ _ e43. PRIMARY CONTAINMENT - V t,STEEL -�3.FfBERGLASS ❑ G.INTERNAL BLADDER --- ------_ 444. I _ __❑ :.STEEL,i_L_\^E_R_NAt LINING ---._- _95_UNKA'Oti'N---0 ".6T-HER(Spkcifv); .-4s f SECONDARY CONTATNh?ENT ❑ 1.STEEL [T3.FIBERGt ASS ❑ G.EXTERIOR NIEMBRLANE LINER 0 7.JACKETED 4s I El 9D.NONE [195.LIN' NIOWN ❑99.OTHER(Sped(y): asa. OVERFILLPREVEIv'T10M 1.AUDIBLE X,VTSUAL:U_AWVS ❑ 2,BALL FLOAT E�t3.FTLLTUBESHUT-OFFVALVE •t-`^ Ej 9.TAT K.LIEETS REQUIREMEWS r`OR EXE I11r7 tD\FROn4 OVEPSILL PREVENTION EOU1Pv7E\Z' V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 0 L SINGLE WAIL M1DOUBLEWALL ❑ 99.OTHER 460. _SYS_?EM TYPE _ __ _[ 1_PRESSURE --❑ ?GRAVITY _- -❑_CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123CCR§-_63Na1_(3_I)_-__-45& PRIMARY CONTAINII'IENT ❑ 1 STEEL 4.FIBERGLASS Q S.FL�IBLE ❑ 10.RIGID PL.0.STIC - 461 ___ _ _ ❑ 90.TONE 95.UNKNOWN _❑ 99.OTHERLSPn - �- - -------- 464a SECOi IE ARY CONTAINMENT ❑ 1.STEEL W 4.FIBERGLASS S_FLEXIBLE ❑ 10.RIGID PLASTIC -- 4646. - _-•------- - - - ❑ 9D_NONE- _[) 95_UNKNOWY - ❑ 99.0TFER(Spcci6-)_ �__-__ -- PIPINE G,`TURBINCONTAINMENT SUMP TYPE ].SINGLE 4t',ALL ❑ 2.DOUBLE WAIL ❑ 90.BORE S64d. VI. VENT, VAPOR RECOVERY(VR) AND RISER/FILL PIPE:PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL 4_FIBERGLASS ❑ 1 C.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): rsJei. VENTSECONDARY CONTAINMENT ❑ I STEEL ❑ 4.FIBERGL--ISS ❑ 10.RIGID PLASTIC 090 &ONT ❑ 99.OTHER(SpetaFi,Y. __.- ------ __.._ ._.....-------- -_--__---____ --• Owe' VRPRIMARY CONTAINMENT ❑ 1.STEEL It 4-FIBEROLASS El 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTTIER(Specify): 4�% VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ElF0,RTGID PLASTIC 464h. 90..[OVE ❑ 99 OTHER(Speciy'): 464h VENT PIPING TRANSITION SUMP TYPE ❑ L SINGLE WALL ❑ 2.DOUBLE WALL 90.NO 4641. RISER PRIMARY CONTAINMENT KV 1.STEEL ❑4.FIBERGLASS ❑ 10,RIGID PLASTIC ❑ 90.DONE ❑ 99.OTHC•R(Specify): 4�f' RISER SECONDARY CONITA INMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify kl. -FILL COMPONENTS rNSTALLED I.SPILL BUCKET 3.STRIKER PLATEsBOTTOM PROTECTOR ❑ 4.CONTA LAMENT SUMP 45!x L- [a...-, o VTI. UNDER DISPENSER CONTAINMENT {UDC) 1,- ftge CONSTRUCTION TYPE _SINGLE WALL-_- -- _-- 0 2..DOUBLE WALL O_J.SRO DISPENSERS 0-9t).NONE a09n CONSTRLICf(ONMATERLkL ❑ 1.STEEL Q9 4.FiBERGLASS ❑ ID.RIGIDPL.ASTIC ❑jWOTHER(SPed'.-I') _ 46c VIII. CORROSION PROTECTION STEEP.COMPONENT PROTECTION ❑ 2.SACRIFTCL4L ANODE(S) ❑ 4.WIPRFSSED CURRENT ' 6.ISOLATION J42 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, aecuntte, od is toll corn nce with I l requirements. [APPLICAa1T STGNATURE DATE 470 Z;PLICANTNIAME(print) i;i 471. APPLICANTTITLE UPCF UST-11 Rev.(I Z2007)-1h wwiv.onidocs.org