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_ ,IFIED PROGRAM CONSOLIDATED FOMW UNDERGROUND STORAGE TANK 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 1,11,111,IV,and IX below) 4'0 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: I3ob I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) ' WEST VALLEY AUTO SPA INC. BUSINESS SITE ADDRESS 103. CITY 01' 2615 West GRANT LINE ROAD I TRACY H. TANK DESCRIPTION TANK ID# 6� 432, TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. s TA 051 S'&- � XERES ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT comPw-ent in the unit DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. JUNE 1, 2004 20,000 ONE III. TANK USE AND CONTENTS TANK USE ® 1&MOTOR VEHICLE FUELING ❑ 1 b.MARINA FUELING ❑ 1 c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(IncWw Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC¢25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ la MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. NON-PETROLEUM:ET 1.USED OIL L1 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.IN I-KNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING _ ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. _ _ ._.. --- -..._ - .--__........._......................... SECONDARY CONTAINMENT ❑ 1.STEEL -- ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445x. OVERFILL PREVENTION a 1.AUDIBLE&VISUAL ALARMS N 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIRENE-N"PS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE ® L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION I23 CCR f2636(a)(3)] 458. PRIMARY CONTAINMENT ❑ 1 STF.F.I. ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ W RIGIDPLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 161b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. PIPINGPTURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE ---464d. VL VENT, VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL [14.FIBERGLASS [Il0.RIGID PLASTIC El go.NONE ❑ 99.OTHER(Specify): 464el. _...----.._.__.____ _w.t VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC N 90.NONE ❑ 99.OTHER(Specify): 4 fi4fl. VR PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [399.OTHER(Specify): 46458: VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 4� VENT PIPING TRANSITION SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90-NONE ........_..-...� ----..-._...._........_...._._.._.. RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46+1. RISER SECONDARY CONTAINMENT ❑ 1.STEFL ❑ 4 FFBF.RGLASS [110,RIGIDPLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATFIBOTI'OM PROTECTOR ® 4.CONTAINMENT SUMP 451 a-c. VII. UNDER DISPENSER CONTAINMENT(UDC) -a CONSTRUCTION TYPE ® L........... ..._.._....---.._.._..........__...._..-........-.._.. _-------- - --.._..-..--- ._asrw_. _.._.......... CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 99.OTHER(Specify) -`� ge: VIII. CORROSION PROTECTION e1�" STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURKEN'I' ❑ 6.!SOLATION ;1A 44R. IX. APPLICANT SIGNATURE CERTIFICATION: ! certify that this UST system is compatible with the hazardous substance stored and that the information pro,.ided herein is true. accurate,and in full com IisgncWith 1 arc uirements. APPLICANT SIGNATURE _GICU DATE 3/28/2011 APPLICANT NAME(print) A HALL 471' APPLICANT TITLE OPERATOR t„