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<br /> UNIFIED PROGRAM CONSOLIDATED]FORM1i/)
<br /> UNDERGROUND STORAGE TANK k
<br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST)
<br /> TYPE OF ACTION (Chock one item only. For an UST permanent closure or removal,complete only this section and Sections I,11,III,1V,and IX below) 410
<br /> ❑ L NEW PERMIT ® 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION
<br /> 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE Q S.UST REMOVAL
<br /> DATE UST PERMANENTLY CLOSED: 4308 DATE EXISTING UST DISCOVERED: 430b
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<br /> $nEi Ex: < +; !;•,,t"�s, ,,-N•x: =;,••,(-..•r :ar.(�,^'{: ?:-„�.:s'� _=fl ` , - -, •li' _ •k„ �ti..lt'i,_,:i 'r• "i '23!vi�.t;.
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<br /> FACILITY ID 0(Agency Use only)
<br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3
<br /> Ramos Oil-French Cam
<br /> BUSINESS SITE ADDRESS 103 CITY 104
<br /> 10842 S.Harlan Road French Camp CA 95231
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<br /> Nil __ -- - tN.,!:'•'' !1ESE<li `'ii(l4it`�'''
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<br /> TANK ID# 437. TANK MANUFACTURER 473 TANK CONFIGURATION: THIS TANK IS 434
<br /> 390005056150505616 XERXES ®1.A STAND-ALONE TANK
<br /> ❑
<br /> 2.ONE IN A COMPARTMENTED UNIT,
<br /> Complete one pp Por each compartment in the wit.
<br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY 1N GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437
<br /> 1 :r•-::.
<br /> 20000 1
<br /> %k•i :4p�!",4knt'. .•:m•rt!?._ ! .Ni
<br /> k,e?Itl.-r!t,•>a,. ... 2.tiLr__...,,,Nnih' w...,an. . 4'44 ',4` .r �'; _ _ - +3 Heti f`ii �?l!"_`•palm_ m _.R.,
<br /> TANK USE ...; .. .• .... :::�,<+»,..:-�;n F,:.: :,
<br /> ® Is.MOTOR VM- ICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION PUELING 439
<br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used 04) ❑ 5.EMERGENCY GENERATOR FUEL[HSC$2528 1.5(e)]
<br /> ❑ 6.OTHER GIENER ATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify)- 43%
<br /> CONTENTS PETROLEUM, ❑ Is.REGULAR UNLEADED Cl lc.MIDGRADE UNLEADED O lb,PREMIUM UNLEADED 440
<br /> IR 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION OAS
<br /> ❑
<br /> S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specif4408
<br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL
<br /> ❑
<br /> 11.OTHER NON-PETROLEUM(Specify): 440b
<br /> _
<br /> ,rt•t:':.�,,,,• �:..:£y _...�., Mme•-•.,i,l .,
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<br /> TYPE OF TANK ❑ I.SINGLE WALL ® 2.DOUBLE WALL Cl 95.UNKNOWN f 443
<br /> PRIMARY CONTAINMENT ❑ 1.STEEL ® 3,FIBERGLASS Q 6.INTERNAL BLADDER 444
<br /> ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (S if 4449
<br /> SECONDARY CONTAINMENT ❑ 1,STEEL IM 3,FIBERGLASS 6.EXTERIOR MEMBRANE LINER ❑ ?.JACKETED 449
<br /> ❑ 90.NONE ❑ 95,UNKNOWN t]99.OT14ERS ify); 44$9
<br /> OVERFILL PREVENTION C1 I.AUDIBLE t VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452.
<br /> ❑ 4.TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E IJIPMENT
<br /> :.,Yf,.?-:i��,';IS?:'r 41 Iw;,;�;. j�.• ,z:¢i°:� �'�. .,,t._. _ iv,_ .W:,ea :•ax.•r; ::,: �t•.. -sti:�Er.:
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<br /> . .., ... ..µiik ...F Ifs'!, .��•,,, ...
<br /> PIPING CONSTRUCTION ❑I.SINGLE-WALLED ®2.DOUBLE-WALLED ❑99.OTHER 460
<br /> SYSTEM TYPE @ I.PRESSURE Q 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4,SAFE SUCTION Et3 CCR$Z636(e)C3) 458
<br /> PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ &FLEXIBLE ❑ 10.RIGID PLASTIC 464
<br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ W.OTHER(Specity); 4640
<br /> SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b
<br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(S i ): 4640
<br /> PIPING/TURWNB CONTAINMENT SUMP TYPE MT SINGLE WALL ❑ 2.DOUBLE WALL ❑ 9o.NONE 4640
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<br /> VENT PRIMARY CONTAINMENT 1.STEEL El 4.FIBERGLASS ]0.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 464c
<br /> 46401
<br /> VENT SECONDARY CONTAINMENT 1.STEEL 4,FIBERGLASS 10.RIGID PLASTIC 19 90.NONE ❑ 99.OTHER(Specify) 464t
<br /> 464n
<br /> VR PRIMARY CONTAINMENT 13 1.STEEL C1 4.FIBERGLASS W RIGID PLASTIC ® 90.NONE ❑ ".OTHER(Specify) 4648
<br /> 464 1
<br /> VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE 99.07HER(Specify) 464h
<br /> 464h1
<br /> VENT PIPING TRANSITION SUMP TYPE M 1.SINGLE WALL 0 2.DOUBLE WALL 19 90.NONE 464;,
<br /> RISER PRIMARY CONTAINMENT ❑ 1,STEEL ❑ 4.FIBEROLASS ❑ 10.RIOW PLASTIC 1@ 90.NONE Q 99.OTHER(Specify) 4641
<br /> 464%1
<br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL. ❑-4-FM EROLASS ❑ 10.RIpID PLASTIC ® 90.NONE ❑ 99,OTHER(Specify) 464k
<br /> 464k1
<br /> FILL COMPONENTS INSTALLED I.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 4SI4 c
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<br /> CONSTRUCTION TYPfi ® !.SINGES WALL Q Z.1)OUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 46%
<br /> CONSTRUCTION MATERW ❑ 1.STEEL Q 4.FIBERGLASS !0.RIGID PLASTIC ❑ 99,OTHER(specify) 469b-c
<br /> :E J�_ si iC^Y1ri tat' ;,nr:...:: ?:r?-=,�t4?; ?r>1 ;' I"_• F °E ' �i "O �9 ,�'Ne
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<br /> . ..�. Nr"F!t 11,13:�Y{kx::...a,�•,'T1.1._.:t.2M,S.
<br /> STEEL COMPONENT PROTECTION Q 2.SACRIFICIAL ANODP(S) ❑ 4.IMPRESSED CURRENT ❑ 6-ISOLATION 446•
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<br /> CERTIFICATION: I certify that this UST system is colnpatihle with the hazardous Substance stored end that the information provided herein iS true,accurate,
<br /> and In full compliance with legal re nireatents.
<br /> APPLICANT SIGNATU ""-� DATE 10/27/2009 A70.
<br /> APPLICANT NAME(print) Dave Nelson °7j' APPI ICANT TITLE Direc of Saf &Compliance 49z
<br /> 8
<br /> 11
<br /> UPCFLI<c/z •d 9c80 'IN 2 �.'. ,V,ldtiE :E 6006 U 'P0,
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