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COX) UNIFIED PROGIWI CONSOLIDATED FORAPI UNDERGROUND STORAGE TAINK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. Por a UST closure or removal,complete onh'this section and Sections 411,111.11;and LYbelon) 430. ❑ 1.NEW PERMIT ❑ 3.RENEIVAL PERMIT N 5.CHANGE OF INFORNIATION ❑ 6.TEMPORARY USI'CLOSURE. ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST RFNIOVAL DATE UST PERMANENTLY CLOSED: alar 1 DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID#(Agenc),use only) _ 1 BUSINESS NAME(.Shine as facility Name a"DBA-Doing Business As) 3 FLYERS #427 BUSINESS SITF ADDRESS 103- 1 CITY 104. 3300 Waterloo Rd. Stockton II. TANK DESCRIPTION TANK LD#-TAC�50-� 4J2• TANK MANUFACTURER 4J3 TANK CONFIGURATION:THIS TANK IS 033_ 02702 TTI1$t0 ® 1.A STAND-ALONE TANK Conplaeone page for tach ❑ 2.ONE IN A COMPARTMENTED UNIT con*--in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436• NUMBER OF COMPARTMENTS IN THE UNIT 437. UnknoWII t) ' a'� 10,000 i III. TANK USE AND CONTENTS TANK USF ® Ia..\iOTOR VEHICLF.FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION'FUELING 339 ❑ 3.CI(F\11CAI.PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used 00) ❑ S.EMERGENCY GENERATOR FULL IiISC¢25231.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN _ ❑ 99.OTHER(Specify): 4193 CONTENTS PETROLEUM: N In.REGULAR UNLEADED ❑ to.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNI"FADED 'too ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S,PETROLEUM BLEND FUEL_ N 9.OTHER P_FT_R_O_L_E_U_M(Specify): 4403 ,\!6N-PETROLEU.,I:❑ 7.USED OIL ❑ l0.L•THANOL ❑ 11.OTHER NON-PETROLEUM(S ify). 440b. IV. TANK CONSTRUCTION TYPE OF TANK_ ❑ 1.SINGLE.WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN __.._._ 443 PRIMARY CONTAINMENT ® I.STFFL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEF.I.+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR IvfEMBRANE LINER N 1.JACKF.TPI) 445. _ __ ❑ 90.NONE C] 95.UNKNOWN [199.OTHER(Specify): 4453. OVERFILL,PREVE_ N ION ❑ I_AUDIBLE R VISUAL.ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR E.\EMPTION FRO\i OVERFILL PREVENTION F UIP•LENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCT_-ION_ _Q 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460 SYSTEM TYPE N 1.PRESSURE _ ❑_2.GRAVITY _ _❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION!23 CCR¢2636(3)(3)] 453. PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 3.FLEXIBLE ❑ 10.RIGID PLASTLC 464. _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): `1641 SECONDARY CONTAINMENT [11.STEEL ® 4.FIBERGLASS ❑ 3.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c__„ PIPINGITURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 46ad. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ®4.FIBERGLASS [110.RIGID PLASTIC [1 90.90.NONE ❑ 99.OTHER S 4644. {.p )} 46641. VENT SECONDARY CONTAINMENT ❑ I.STEEL 1:14-FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464n. -- - 464&x VR PRINIARY CONTAINMENT ❑ L STEEL 10 4.FIBERGLASS (jE)_ ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify): 4464 . VR SECONDARY CONTAINMENT ❑ 1.STEEL _ ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE" ❑ 99.OTHER(Specify): 46 hl. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641 RISER PRIMARY CONTAINMENT N 1.STEM, ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46%i1. RISER SECONDARY CONTAINMENT [11.STEEL_ [34.FIBERGLASS [I10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464ki_ FILL CON•fPONF.,N"fS INSTALLED ® 1.SPILL BUCKET _® 3.STRIKER PLATE/BOTTOM 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 CONSTRUCTION IvWrERIAL ® 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC (199.OTHER(Specify) W` 4694 VIII. CORROSION PROTECTIONh STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIALANODE(S) ❑ 4.Ih1PRFSSEDCURRENT ❑ 6.ISOLATI ' .. 'ZO 448 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system Is con'pntible with the hazardous substance stored and that the Inforn "' rovided 1101-011 IS true, accurate, 1 In full con'4liaace with legal re uirements. " � APPLICANTSIGNATURF DATE 5/18/2012 470. APPLICANT NAME Or"11) Amanda Appelt 471. APPLICANT TITLE EIIVIT011l112 anagen 47z LIPCF UST-B ltev.(1212007)-1/2 www.unldocs.org f