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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE,OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,111,IV,and IX below) 430 ❑ I.NEW PERMIT ❑ 3 RENEWAL PERM[' ® 5.CHANGE OF INFORMATION 6,TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL, DATE UST PERMANENTLY CLOSED: 430e I DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID N(Agencv Use Onh) I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 AT&T CoM. CAK482 BUSINESS SITE ADDRESS03 CITY 104 110 West Turner Road Lodi II.TANK DESCRIPTION TANK ID tt 132 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 605 MODERN WLD ®1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Complete one page for each com anment in the unit. DATE UST SYSTEM INSTALLED J35 TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENTS INTHE UNIT 437 1/2001 15000 1 III,TANK USE AND CONTENTS TANK USE ❑ la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 0 ,.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used 01) ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25281.5(c)J ® 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a CONTENTS PETROLEUM' ❑ la.REGULAR UNLEADED ❑ lo.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 011, ❑ 10.ETHANOL' ❑ 11.OTHER NON-PETROLEUM(Specify): i 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® I.STEEL 3,FIBERGLASS 0 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ I.STEEL. ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED J45 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a 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 I WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I.SINGLE-WALLED 1@ 2.DOUBLE-WAILED-[]99.OTHER 460 SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.GRAVITY 0 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR§26361x)(3)) 458 PRIMARY CONTAINMENT ® 1.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 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 1.STEEL ® 4.FIBERGLASS 10.RIGID PLASTIC 0 90,NONE 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE. ❑ 99.OTHER(Specify) 464f 464f1 VR PRIMARY CONTAINMENT 1,STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 4648 ___464&1__ VR SECONDARY CONTAINMENT 0 1,STEEL C3 4.FIBERGLASS 10.RIGID PLASTIC ® 90 NONIi ❑ 99.OTHER(Specify) 464h 464h I VENT PIPING TRANSITION SUMP T'YPF.' 1 SINGLE WALL 2.DOUBLE WALL 90.NONE 464. RISER PRIMARY CONTAINMENT 0 I.STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC U 90.NONE ❑ 99.OTHER(Specify) 4643 46d I RISER SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 0 90.NONE 99.OTHER(Specify) 4641, 464k1 FILL COMPONENTS INSTALLED 0 I.SPILL BUC'KE'T R .3.STRIKER PL.ATEBOTTOM PROTECTOR Cj 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ® 3.NO DISPENSERS ❑ 90.NONF 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b.c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX, APPLICANT SIGNATURE CERTIFICATION: 1 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. .6/1 1/2008 APPLICANT NAME(print) 471, APPL.ICANTTITLE 472. Steven J Hall Manager, EH&S UPCF UST-B-1/1 Rev.(12/2007)