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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (('heck one item only. For an TJST permanent closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) 430 ❑ L NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION 6.TEMPORARY USTCLOSURE 0 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a 1 DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID#(Agencv Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Pacific Bell Telephone Company dba AT&T Califomia UE058 BUSINESS SITE ADDRESS 103 1 CITY 104 10 East 12"Street Trac II.TANK DESCRIPTION TANK ID# 412 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 1103 MODERN WLD ®1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Complete one page for each compartment in the wta. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 2001 10000 1 III.TANK USE AND CONTENTS TANK USE ❑ la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING E] Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used CAI) ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25281 5(c)) ® 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL. ❑ 11.OTHER NON-PETROLEUM(S eci'): 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE.WALL ® 2.DOUBLE WALL 95.UNKNOWN 443 PRIMARY CONTAINMENT I.STEEL 3.FIBERGLASS ❑ 6.INTERNAL 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): 445a OVERFILL PREVENTION I.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 ❑ 1.SINGLE-WALLED 0 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.GRAVITY ® 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(x)(3)) 458 PRIMARY CONTAINMENT 0 I.STEEL ❑ 4.FIBERGLASS ® S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464. SECONDARY CONTAINMENT ❑ 1.STEEL 4 FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 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 U 1.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify) 4641' 4641`1 VR PRIMARY CONTAINMENT I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE 99.OTHER(Specify) 4646 464 I VR SECONDARY CONTAINMENT ❑ 1.STEEL. ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE 1,SINGLE WALL ❑ 2.UOUBLE WALL -9-0N ON E 464, RISER PRIMARY CONTAINMENT ® 1.Sl'EEL 4.FIBERGL:1SS 10.RIGID PLAS"fIC ❑ 90 NONE ❑ 99.OTHER(Specify) 464) _164j I RISER SECONDARY CONTAINMENT El 1.STEEL 0 4.FIBERGLASS 0 10,RIGID PLASTIC 90.NONE ❑ 99.OTHER(Spec]ty) 464k 464k) FILL COMPONENTS INSTALLED 1.SPILL,BUCKET M 3.STRIKER PLATEtBOT'rOM PROTECTOR 0 4.CONTAINMENT SUMP 451a-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL. 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(S ecit'y) 4b9b-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL.ANODF(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448, IX. APPLICANT SIGNATURE CER'rl FICATION: 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 requirements. APPLICANT SIGNATURE DATE 470 ..�. 6/3/2008 APPLICANTNAME(print) 471 APPLICANTTITLE 472 Steven J Hall Manager, EH&S UPCF UST-B-1/1 Rev.(12/2007)