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UNIFIED PROGRAM CONSOLIDATEF FORM UNDERGROUND STORAGE TANK (� OPERATING PERMIT APPLICATION-TANK INFORMATION (On:fornm per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 411,121,IV and IX below) Oso• \t ❑ I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE ❑ 9 UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 430' I. FACILITY INFORMATION riq-d DD 3 1,,f7 FACILITY ID k(Agency Use Only) - 1' BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3' AT&T Corp. BUSINESS SITE ADDRESS 103. CITY 104. 90 W.Turner Road Lodi II. TANK DESCRIPTION TANK ID N 432• TANK MANUFACTURER 433• TANK CONFIGURATION:THIS TANK IS 434. M I-A STAND-ALONE TANK Complete one page roreach UE231 U001 Toor ❑2.ONE IN A COMPARTMENTED UNIT compVuWt in theuMG DATE UST SYSTEM INSTALLED 435• TANK CAPACITY IN GALLONS 436• NUMBER OF COMPARTMENTS IN THE UNIT 437. III. TANK USE AND CONTENTS TANK USE ❑ to.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑3.CHEMICAL PRODUCT STORAGE [14.HAZARDOUS WASTE(Includes Used Gil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC V5281 5(e)) M 6.OTHER GENERATOR FUEL •❑ 95.UNKNOWN ❑ 99.OTHER(S acify): 4394. CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ❑ lo.MIDGRADE UNLEADED ❑ I b.PREMIUM UNLEADED 440. ®3.DIESEL ❑5.JET FUEL ❑ 6.AVIATION GAS (3 S.PETROLEUM BLEND FUEL ❑9.OTHER PETROLEUM(S ecify): 4404. NON-PETROLEUM:❑ 7.USED OIL 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify).- 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL2.DOUBLE WALL ❑95,UNKNOWN 443' PRIMARY CONTAINMENT ® I.STEEL ❑3.FIBERGLASS [36,INTERNAL BLADDER 444 ❑7.STEEL+INTERNAL LINING ❑95,UNKNOWN ❑ 99.OTHER(Specify): ,4441 SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑6.EXTERIOR MEMBRANE LINER 537.IACKETED 445. ❑90.NONE ❑95.UNKNOWN [199.OTHER(Specify): 445x' OVERFILL PREVENTION IN 1.AUDIBLE&VISUAL ALARMS M 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. [14.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT 1 WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ®2.DOUBLE WALL ❑99.OTHER......., 460• SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.GRAVITY M 3.CONVENTIONAL SUCTION [14.SAFE SUCTION 123 CCR§7636(-X3458, PRIMARY CONTAINMENT ® L STEEL ❑ 4,FIBERGLASS ❑S.FLEXIBLE ❑ 10,RIGID PLASTIC 464. ❑ 90.NONE [1 95.UNKNOWN ❑.99.OTHER(S edfy): 4644 SECONDARY CONTAINMENT 1] 1.STEEL I9 4.FIBERGLASS ❑ S.FLEXIBLE EIt0.R[GID PLASTIC 464b. ❑ 90.NONE [195.UNKNOWN [399.OTHER(Specify): 464c PIPING(rURBINE CONTAINMENT SUMP TYPE RI 1.SINGLE WALL [12.DOUBLE WALL ❑90.NONE 4644, VI. VENT,VAPOR RECOVERY(VR)AND RISER 1 FILL PIPE PIPING CONSTRUCTION VENTPRIMARY CONTAINMENT ❑ 1.STEEL IN 4.FIBERGLASS [110.RIGID PLASTIC E]90-NONE [I 99.OTHER(Specify)- 464s1. VENT SECONDARY CONTAINMENT [11.STEEL ❑4.FIBERGLASS [I10,RIGID PLASTIC ® 90.,NONE [1 99 OTHER(Specify): 464L Tag. VR PRIMARY CONTAINMENT Ill 1.STEEL ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90,NONE ❑ 94 OTFIER(Specify}: 464 I, VR SECONDARY CONTAINMENT [31.STEEL [34.FIBERGLASS ❑ I0.RIGID PLASTIC M 90.NONE [I99,OTHER(Specify): 4d hl, VENT PIPING TRANSITION SUMP TYPE [3L SINGLE WALL ❑2-DOUBLE WALL ®90 NONE 4 RISER PRIMARY CONTAINMENT ® I•STEEL ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [199.OTHER(Specify): 4649. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC ISI 90.NONE [199.OT14ER(Spcc4. g64k1, FILL COMPONENTS INSTALLED 12 1.SPILL BUCKET M 3.STRIKER PLATE(BOTTOM PROTECTOR ❑4,CONTAINMENT SUMP 45la-a VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ i.SINGLE WALL ❑2,DOUBLE WALL M 3.NO DISPENSERS ❑90.NONE 4694. 46W. CONSTRUCTION MATERIAL ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC ❑99.OTHER(Spccily) 469c_ VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION [12.SACRIFICIAL ANODES ❑4.IMPRESSED CURRENT 6.ISOLATION 448• IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous sabstauce stored and that the information provided herein is true, accurate and in full VVnpikmo wit al re uirements. 470. APPLICANT SIGNATURE _ DATE 5/21/2015 APPLICANT NAME(print)Kevin 471 APPLICANT TITLE 47z Majiagcr UPCF UST-B Rev.(1111007)-112 www.unidots.org