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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,[I,III,IV,and IX below) ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 430b DATE UST PERMANENTLY CLOSED: 43oa DATE EXISTING UST DISCOVERED: I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 4 3 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) National Petroleum-Stockton 104 BUSINESS SITE ADDRESS 103 CITY 713 N.EI Dorado St. Stockton II.TANK DESCRIPTION 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 TANK ID# TA0515677 Xerxes ❑1.A STAND-ALONE TANK ®2.ONE IN A COMPARTMENTED UNIT. Com fete one page for each com amen in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 12/20/2003 12,000 2 III.TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] 439a ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): CONTENTS PETROLEUM: ❑ 1 a.REGULAR UNLEADED ❑ 1 e.MIDGRADE UNLEADED ® 1b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 440a ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER-PETROLEUM (Specify): NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 440b ❑ 11.OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION 443 TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 444 PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444a ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN [199.OTHER (Specify): 445 SECONDARY CONTAINMENT ❑ 1.STEEL N 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445a ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify) 452. [OVERFILL PREVENTION ❑ 1.AUDIBLE 8c VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-0FF VALVE❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTIONa6o PING CONSTRUCTION ❑1.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99.OTHER 458 YSTEM TYPE M 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(.)(3)] 464 RIMARY CONTAINMENT ❑ l.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464b IN SECONDARY CONTAMENT ❑ 1.STEEL P9 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ l0.RIGID PLASTIC 464c ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464d PIPING/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL [12.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464e VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e1 464f VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464171 464g VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464 1 VR SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [110.RIGID PLASTIC [390.NONE [199.OTHER(Specify) 464h4601 4641. VENT PIPING TRANSITION SUMP TYPE ® 1.SINGLE WALL ::12.DOUBLE WALL ❑ 90.NONE 4M] RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464,1 464k RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46441 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451a-c VII.UNDER DISPENSER CONTAINMENT(UDC) 469. CONSTRUCTION TYPE ® 1.SINGLE WALL [12.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469b-c CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) VIII. CORROSION PROTECTION 448. STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) [14.IMPRESSED CURRENT ® 6.ISOLATION 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,accurate, and in full compliance with legal re uirements. azo. APPLICANT SIGNATURE v DATE 3/20/2014 472. APPLICANT NAME(print) Nick Patel 471. APPLICANT TITLE Manager Rev.(12/2007)