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F-1 mu '_F-IFIED�PROG�RAiM�CONSOLIDATED 7FOT 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 1, 11, 111, IV, and IX below) 430 [1 1. NEW PERMIT [] 3. RENEWAL PERMIT Z 5. CHANGE OF INFORMATION El 6. TEMPORARY UST CLOSURE E] 7. UST PERMANENT CLOSURE ON SITE [1 8. UST REMOVAL, DATE UST PERMANENTLY CLOSED: 43oa DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) Unified Grocers, Inc BUSINESS SITE ADDRESS 103 CITY 104 1990 Piccoli Road Stockton 11. TANK DESCRIPTION TANK ID # 2 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 Modem Welding Co. 0 1. A STAND-ALONE TANK Fresno, CA El 2. ONE IN A COMPARTMENTED UNIT. Complete one pMe for each corn2artrncnt in the unit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 Upgraded 1998 20,000 one 111. TANK USE AND CONTENTS TANK USE 0 Ia. MOTOR VEHICLE FUELING 0 lb. MARINA FUELING D lc. AVIATION FUELING 439 ❑ 3. CHEMICAL PRODUCT STORAGE 0 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 5. EMERGENCY GENERATOR FUEL [HSC §25281.5(c)] ❑ 6. OTHER GENERATOR FUEL 0 95. UNKNOWN ❑ 99. OTHER (Specify): 439a CONTENTS PETROLEUM: [I Ia. REGULAR UNLEADED 0 lc. MIDGRADE UNLEADED ❑ Ib. PREMIUM UNLEADED 440 0 3. DIESEL 0 5. JET FUEL 0 6. AVIATION GAS C] 8. PETROLEUM BLEND FUEL [1 9. OTHER PETROLEUM (Specify): 440a NON -PETROLEUM: 0 7. USED OIL C] 10. ETHANOL ❑ 11. OTHER NON -PETROLEUM (Specify): 440b IV. TANK CONSTRUCTION TYPE OFTANK- 0 I. SINGLE WALL 1@ 2. DOUBLE WALL [1 95. UNKNOWN 443 PRIMARY CONTAINMENT 0 LSTEEL El 3. FIBERGLASS [1 6. INTERNAL BLADDER 444 0 7. STEEL + INTENAL LINING [1 95. UNKNOWN 0 99. OTHER (Specify): 444a SECONDARY CONTAINMENT 0 I. STEEL [1y3: FIBERGLASS [1 6. EXTERIOR MEMBRANE LINER El 7. JACKETED 445 ❑ 90. NONE 95. UNKNOWN ❑ 99. OTHER (Specify): 445a OVERFILL PREVENTION ❑ 1. AUDIBLE & VISUAL ALARMS [1 2. BALL FLOAT 3. FILL TUBE SHUT-OFF VALVE 452. 0 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE -WALLED 0 2. DOUBLE -WALLED 0 99. OTHER 460 SYSTEM TYPE 0 1. PRESSURE 0 2. GRAVITY F_] 3. CONVENTIONAL SUCTION [1 4. SAFE SUCTION t23 CCR §2636(a)(3)] 458 PRIMARY CONTAINMENT ❑ 1. STEEL 0 4. FIBERGLASS [1 8. FLEXIBLE 0 10. RIGID PLASTIC 464 ❑ 90. NONE [:1 95. UNKNOWN ❑ 99. OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE El 10. RIGID PLASTIC 464b Ej 90. NONE [1 95. UNKNOWN 0 99. OTHER (Specify): FRP 464c PIPING/TURBINE CONTAINMENT SUMP TYPE [1 1. SINGLE WALL 0 2. DOUBLE WALL ❑ 90. NONE 4644 VI. VENT, VAPOR RECOVERY (VR) AND RISER/ FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 1. STEEL ❑ 4. FIBERGLASS El 10. RIGID PLASTIC [1 90. NONE 0 99. OTHER (Specify) 464e 464el VENT SECONDARY CONTAINMENT [I I. STEEL 0 4. FIBERGLASS El 10. RIGID PLASTIC [1 90. NONE [1 99. OTHER (Specify) 464f 464fl VR PRIMARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC [1 90. NONE El 99. OTHER (Specify) 4648 ,464gl VR SECONDARY CONTAINMENT ❑ 1. STEEL E] 4. FIBERGLASS [1 10. RIGID PLASTIC [1 90. NONE [3 99. OTHER (Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE 0 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 4641. RISER PRIMARY CONTAINMENT ❑ LSTEEL [1 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE [1 99. OTHER (Specify) 464j 464'1 RISER SECONDARY CONTAINMENT ❑ LSTEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC Ej 90. NONE 0 99. OTHER (Specify) 464k 464kI FILL COMPONENTS INSTALLED ❑ I. SPILL BUCKET [1 3. STRIKER PLATE/BOTTOM PROTEgTDjZ_' _0 4. CONTAINMENT SUMP 45 1 a -c I VII. UNDER DISPENSER CONTAINM T (UDC)) CONSTRUCTION TYPE ❑ 1,:'SINGLE WALL 0_2. DOUBLE WALL--,_[] 3. N_QOISPENSERS r_1 90. NONE 469a CONSTRUCTION MATERIAL 1. STEEL [1 4. FIB��-f-�_] Ib. RIGID PLASTIC 0. OTHER (Specify) 469b -c VIII. ('%_ORROq2t�EROTECTION STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(sk- J�4. IMPRESSED CURRENT ❑ 6. ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate, #i1d ig" jmpliance with legal requirements. APPLICANT S DATE 12/24/2008 470. APPLICANT I(IAME (P44 Patrick Guillermety 471. APPLICANTTITLE Director Environmental Health 472. & Safety UPCF UST -B -1/2 Rev. (12/2007)