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UNIFIED PROGIWI CONSOLIDATED FORIIM UNDERGROUND STORAGE TANK OPERATING PERIVIIT APPLICATION-TANK INFORMATION (One toms per UST) TYP F OF AC710N (Check one items only. For a UST closure or removal,complete only this section and Sections[,11,Ill,IV,,and Lr belost) 430. ❑ 1.NEW PFRMIT ❑ 3.RENEWAL.PERNIIT N 5.CHANGE OF INFORMATION ❑ 6.TE4IPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL Own. DATE UST PERMANENTLY CLOSED: 4303- BATE EKISTING UST DISCOVERED; I. FACILITY INFORMATION FACILITY ID#P(Agency Use Only) 1 3, BUSINESS NAME(Scone as Facflity None or DBA-Doing Business As) FLYERS #427 BUSINESS SITE ADDRESS 103. CITY t03' 3300 Waterloo Rd. Stockton II. TANK DESCRIPTION TANK Ill H "� 43z. "TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434 IR 1.A STAND-ALONE TANK Complete one page for each 42703 TruscO ❑ 2.ONE INA COMPARTMENTED UNIT eompn-ntinthe unit, DATE UST SYSTEM INSTALLED435• TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS m THE UNIT 437. Unknown t)A:O'C`I3 12,000 1 III. TANK USE AND CONTENTS "TANK USE N In.MOTOR VEHICLE FUELING ❑ lb.IalARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Otl) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5O]] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): _ 93 aa0. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADF.UNLEADED ❑ ib.PRF.MIUAI UNLEADED ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 4403- ❑ S.PETROLEUM_BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): _ NON-PETROLEUM:C17.USED OIL ❑ 10.ETHANOL aaoh ❑ 11.OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2-DOUBLE WALL ❑ 95.UNKNOWN 43 PRIMARI'CONTAINMENT N 1.STEEL ❑ 3.FIBERGLASS ❑ 6. -s44- INTERNAL BLADDER 444x ❑ 7.STEEL+INTER,NrAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): _. SECONDARY CONTAINMENT ❑ I.STEEL 133.FIBERGLASS [16.EXTERIOR MEMBRANE LINER ® 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445a OVERFILL PREVENTION ❑ I.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT N 3.FILL TUBE SHUT-OFF VALVE 152 ❑ 4.TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTION_ ❑ 1.SINGLE WALL ®2.DOUBLE WALL ❑ 99.OTHER _ _ SY5TEI4i TYPE _ ® !.PRESSURE. ❑ 2.GRAVITY ❑ 3.CONVENTIO_NAI.SUCTION ❑ 4_SAFE SUCTION 123 CCR§2636(a)(3p ries 4w. PRIMARY CONTAIMIENT [31.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RiG1D PLASTIC ❑ 90.NONE ❑ 95.UNKNOWN F-) 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑95.UNKNOWN ❑ 99.OTHER(Specify): arc'_. PIPING(TURBINF CONTAINMENTSUMP TYPE C11.SINGLE WALL [32.DOUBLE WALL ❑ 90.NONE: 464d VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRINIARY CONTAIN?vIENT ❑ I.STEEL N 4.FIBERGLASS [110.RIGID PLASTIC ❑ 90.NONE [399.OTHER(Specify): 464cE _ 463E VENT SECONDARY CONTAINMENT (:I ).STEEL ❑ 4.FIBERGLASS ❑ 10-RIGID PLASTIC N 90.NONE ❑ D9.OTHER(Specify): 4dfl- VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTllER(Specify): 46�$. _ a63h. VR SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ l0.REGIDPLASTIC ® 90.NONE [j99.OTf1ER(Specify): 464n1. a63i VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL N 90.NONE. 463j RISER PRIMARY CONTAINMENT N 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): .4641. _ 464k. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Sped$): 464kl. t..._ _.. ... SUMP - -'- 451n-c. FILL COMPONENTS INSTALLED N 1.SPB.L BUCKET ® 3.STRIKER PI.ATUBOTTOM PROTECTOR ❑ 4.CONTAINMENT VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS 0..90.NONE, 469a a69t,.. CONSTRUCTION MATERIAL N 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 44S. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with tine hazardous substance stored and (lint the inforillotio"provided Ile] Is b ue, neciii,qte,ArmtinftlllcolllpliallcewitilI aI re uirements. 470. APPLICANT SirNATU DATE 5/18/12 APPLICANT NAMF,(print) 471' APPLICANT TITLE Environmental Manager ;72 Amanda Appelt g UPCF UST-13 Rev.(1212007)-1#2 n33w.unid0cs.org