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LMFIED PROGRAM CONSOLIDATED FO _ 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 1,11,111,1V,and DCGeloev) a30 Q 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: 430b I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 NELLA Oil Company LLC #427 BUSINESS SITE ADDRESS 103. CITY 104, 3300 Waterloo Rd. Stockton II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434- 42703 TruseO ® I.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437, Unknown 10,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ le.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.OTHERS(Specify): 439x. ............................._....._N........._Y).:.. ....................................._.........._......................................................................_..-.._......................................_..............................................................-....-_...__..................._..__......................_........................................... _.0...... CON TENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED aa0. ❑ 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ® 9.OTHER PETROLEUM(Specify): Red Diesel anon. ................._....... ......._................. .......... ...._......._...... ....... ........._..... NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ......... .......................................... PRIMARY CONTAINMENT Z.1.STEEL [1 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING INTEEl 95.UNKNOWN El 99.OTHERe4 _........_.........._............. ................................._........................ ..._................._......._._._............__............................__..................._...__........._._�._Scif 4a (Specify): a. ...... SECONDARY CONTAINMENT E] L STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN El 99.OTHER(Specify): 44 1.5a. . . .. . ............ ......-...._.......................................................... OVERFILL PREVENTION ❑ 1.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 El 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. _....._....._.................__..............................._._..............................__............................._............_............................................................... ......................................_.... SYSTEM TYPE ® 1.PRESSURE 2.GRAVITY ❑ 3_CONVENTIONAL SUCTION 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458, PRIMARY CONTAINMENT ElL STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. ... .................................................._......._..................-...........................-.............__......................_.................__......_...._..-..................._..........................-........._....._.....-......................_.._................................. ................................................ SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC a6ab. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. -...._......................._....................._._............................ ..._.._.._..__...-.._.....__..__.._.._............__...._.__._............._........_.._._..._..........._......._..... ....__. .......... PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT El1.STEEL ® 4.FIBERGLASS E] 10.RIGID PLASTIC ❑ 90.NONE [199.OTHER(Specify): 464e 1. ..........-..........................................................._.........._._................................__................_.......................__._......._......._..._............_._.................................__..................._......_........._........................_................-.....-_.........._............._...._........._..._._.._....-_.....................__....._........_........._.............. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464( ......._......................... ... 464f I. ................. ..........................._----------........._. .................................................._._..._..................................................................................................._....................__....._........_.._._............................_....._...................._......_._............_....._..................................... 4648. VR PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46a&I ......................................................................_.__.................................... ..................._......_............._...................................._....................._,.................................................._..._..............__._......_......_...............................................___...................._.._......................................................_........................ 464h. VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h1 ..........._.-.............................................................._.................................................................................._................................................................................................_._.........................................................._..............................._......................................................._........................................ .... V ENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 46ar. ............................................._............._...............................................................................___........................._..............................................._....................................__.___................_......................................... .......................... .............................................._.............._... ...................._.......... ..............__...._....._.................. ._......_4_... RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46641,.... ..............._.........................................._._....._..........__.._..................................._...................................................................-._.............................................. ................................................................................._........................_.............................................................................................. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464k1. _................................................................................................_..............................................._.. .............._......-................._..........._.._.........................__,.................................._........................__.................._.. ._.......................-..............._..............._.- PON. FILL ENTS INSTALLED ❑ 1.SPILL BUCKET ® 3.STRIKERPLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a. .. ........__..._.__.....__........__...._..........._._............................_._._..............................................................._............._.............. .. _............_...._......_............469........ .-...___.........._................_...._........................._...........................-............................................................................__......._._......................................_..............__.....___._.. CONSTRUCTION MATERIAL ® 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 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify th his UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurat non ful pliance with legal requirements. APPLICANTSIGNATUR DATE 12/11/2009 470 APPLICANT NAME(prin 471. APPLICANT TITLE 477 Don B ely Envrionmental Compliance nn�r. ■rc�r o o,.., n�i�nn�� its --•--......_:a,..,...._..