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Mar 29 10 08:09a Reliable PetroleumA 209-845-8953 P.1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK LIN FORhIATION(One farm per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or remora,complete only this section and Sections(,[I,III.I V,and IX below) a3o ❑ ].NEW PERMIT 3.RENEWAL PERNfIT ❑ 5.CHANGE OF INFORMATION © 3.TEMPORARY UST CLOSURE n i.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: c700 DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID 1(Age»cy�Lrse prvyl f BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) C 3 BUSINESS SITE ADDRESS r, 103 l '-� i ttw It.TANK DESCRIPTION TANK IDK 432 TA N-K MANUFACTURER 433 r� TANK CONFIGURATION: THIS TANK IS 434 >'� ❑1.ASTAND-ALONE TANK ��-O1�E W A COAiPARR77ti£.TED UNIT. DA TE UST SYSTEMI,YSTALLED 435 CII tele-I' a.fareachcom rtmentinth_LLir. TANK CAPACITY IN GALLONS �Iu NUMBER OF COX-JPART IENTS IN THE UNIT 437 SCC: I.TANK USE AND CONTENTS � TANK USE (� la_MOTOR VEHICLE FUELLYG `-'+ ❑ ib.MARNA FUELING ❑ Ic.AVIATION FUELING 439 El 3_CHE MiCAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Indade,Used Di!> Q 5.EMERGENC'C GENERATOR FL-EL[HSC;25291.5(c)) Q 6.OTHER GE 4ERATOR FUEL ❑ 95.UNKNOWN Q 99.OT>ER(Sparify 4392 CONTENTS PETROLEUM: ❑ 1a.REGULAR UNLEADED ❑ lc MIDGRADE UNLEADED ❑ lb•PREMUNLEADED a4aI93_DIESEL ❑ 5_JET FUEL Q b.AVIATION G.4S ❑ &.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify). NOIN-PETROLEUM:❑ 7.USED Or4a0a ❑ 10_ETHANOL ❑ 'L OTI(ERNON-PETROLEL',v,(S ecifv): IV. TANK CONSTRUCTION 440b TYPE OFTANK ❑ 1.SINGLE LVALL 2.DOUBLE WALL ❑ 95.LryKNOWIJ PRIMARY CONTAINMENT ❑ I.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER -441 ❑ 7-STEEL+INTERNAL LINING 444 SECONDARY CONTAINMENT ❑ 95.LT1KNOWN ❑ 99,OTHER ❑ T.STEEL 3.FIBER(LASS ❑ 6.EXTERIOR MEMBRANE LINER ❑S7-)q METED 44aa ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OT14ER(S :?r3. ) OVERFILL PR ENT1Cr� [] 1.AUDIBLE&VISUAL ALAR\15 ? 445a ❑ .BALL FLOAT FILLTUBESHUT-OFF VALVE❑4-TANKMEETS REQUIREN ENTS FOR EXEMPTION FROMOVL PREVENTION EQUIPALEN\rI- V. PRODUCT/WASTE PIPING CONSTRUCTION P[PING CONSTRUC JOY 1.SINGLE-WALLED DO(iBLirt1 ALLED ❑99.017fER Sl'STEbITYPE 1.PRESSURE ❑ 2.GRAVITY ❑ 3.LUNVE'.TIONALSUCTION ❑ 4.SAFESt1CflON Jz3 Cc25z6361a)(3) ,ice ' PRIMARY CON'TAIT MENT ❑ 1.STEEL 4.FIBERGLASS ❑ 3.FLEXIBLE ❑ 90.NONE ❑ 95_UWKNOWN ❑ 10.RIGID PLASTIC 464 SECONDARY CONTAINMENT ❑ OTTiER(SP )' 464a ❑ 1.5TEEL t.FIBERGLASS ❑ 8.I-LE IBLE ❑ 10.RIGID PLASTIC 464b ❑ 90. 95.UNKNOWN ❑ 99.OTHER fSpecify): NPIN&TURBTNE COR7AINAJEVT SUMP TYPE I.SINGLE WALL L-1 2.DOUBLE WALT 454e VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTI03� 46,d VENT PRIMARY CONTAINMENT ❑ I.STEEL 4,FIBERGL 15S ❑ 10.RIGID PLASTIC ❑90.NC!NE I] 99.OTHER(Specii4) 464e VENT SECONDARY CONTAINS9ELT ❑ I.STEEL ❑ 4.FIBERGLASS Ll 10.RIGID PLASTIC JA 90.NONE ❑ 99.OTHER(Specify) 41 ; V R PRIMARY COtvTA1.YSIENT ❑ L STEEL4.FIBERGLAS$ LJ I0.RIGID PL.tSTIC of rf! Q 90.\ONE Q 99.OTHER(Specify? 4649 VRSECONLIARYCONTAINT.-EENr ❑ I.STEEL ❑ 4.FIBERGLASS D 10_RIGIDPLASTIC 90.NONE ❑ 99.OTHE32(Speci ) ' 0h 1 E\rr PIPING TRANSITION SUMP TYPE NGLE 1V.4LL 2 ! p 46-th1 RISER PR[A1.4RY CO`T,(iNN-FENT f.a(EEL ❑ -IIL E WALL 90.NONE wai ❑ 4.FIBERGLASS ❑ 10-RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(SpeeiB•j 464j RISER SECONDAR)"CONTAIN14ENT ❑ i.STEEL 4.FIBERGLASS =1 .RIGID?LASTIC 64'1 D.NONE 99.OTHER(Sp:ciiy) 4"k I11LCO:L(PCINTSINSTALLED 1.SPILLBUCiOT LJ3.STRIKERPLAlE•BOTIONIPROTECTOR 4.CONTAIN0.tEVTSUAIP �Siak-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE I.SINGLE WALL ❑ 2.DOUBLE WALL CONSTRUCTION MATERIAL L-1 I.STEL 4.FIBERGLASS ❑ ID.RIGID PLASTIC ❑ A KBSEROTHER(Specify) ❑ 90.NONE 99 a6yt VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 4.L 1PRESSED CURRENT b.[.c OLATtOkN 448. IX. APPLICANT SIG NATURE CERTIFICATI N. rtify that this UST Syste compatible with the hazardous substance stored-nud that the information prostided herein is true,accurate, din f I nl re uirements. APPLICAN DATE 4�0. APPLICA (print) / 471 APPLICANT iTLE s3z. UPCF'UST-8-1/2 Rev.(12/2007)