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i 7 i'1t'�a A- M, p 'I✓�J{{�-l� �jliS 1 "11Ti L It A 1 fX ?I A� 3��1� _ �., J On.,.._...oin For nCr,..._r11,._c.t .._ -. his sec E OF dPO° �� r C I^. r 2, r 1 P� vfA':i_EN_,'CLC,,, i " L _- _ 43C, D,,- - 43uo� ?;ut ✓. AT nay Use G.^''j 3 NAME(Same:..,.. '..,ILt: , t�:,:/I_ or Lw ::`ed Grocers, Inc i CIT. 1°4 BLSiNESS SITE ADDRESS lc3 V f i v90 Piccoli Road Stockton II,T NX DESCRIFTION TANK ID 7 2 432 TANK MANUFACTURER 433 T,=NKCONF[G1,R.Tio;a: THIS TANK IS 43' Modem Welding Co. 1,A STAND-ALONE TANK Fresno,CA ❑2.ONE IN A COMPARTMENTED UNIT, Complete one page for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 43� Upgraded 1993 --- 20,000 --- oile -- III.TAINR USE AND C01,ITEN TS TANK USE 0 la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 4'9 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§23281.5(c)] ❑ 99.OTHER (Specify): 439a El 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN 4a0 CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 440a ❑ 8.PETROLEUM[BLEND FUEL - ❑ 9.OTHER PETROLEUM (Spec&j): NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 440b ❑ 11.OTHER NON-PETROLEUM(Specify): IV. TANNIC CONSTRUCTION TYPE OFTANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTANMENT 0 1.STEEL ❑ 3.FIBERGLASS ❑ 6.NTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ® 1.STEEL N 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 4'2 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SNGLE-WALLED ®2.DOUBLE-WALLED C399.OTHER 460 SYSTEM(TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)) 458 PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ® 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN E] 99. 99.OTHER(Specify): 464b SECONDARY CONTAINMENT ❑ 1.STEEL C] 4.FIBERGLASS ❑ 8.FLEXIBLE El 10.RIGID PLASTIC 464c ❑ 90.NONE ❑ 95.UNKNOWN ® 99.OTHER(Specify): FRP 464d PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464(1 VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464g 464g[_ VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4641. RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464j l RISER SECONDARY CONTAINMENT ❑ 1.STEEL [34.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED ❑ 1.SPILL BUCKET ❑ 3.STRIKER PLAT&BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451a-c _. VII.UNDER DISPENSERCONTAINM1 9, IT(UDC)` CONSTRUCTION TYPE 1.SINGLE WALL2.DOUBLE WALL -,. ❑ 3.NO DISPENSERS [190.NONE 469a CONSTRUCTION MATERIAL 1.STEEL C14.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b c VIII.(CORROSIONV'PROTECTION STEEL COMPONENT PROTECTION El 2.SACRIFICIAL ANODE(S),, [14.IMPRESSED CURRENT 6.ISOLATION a48. IAC. 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, d ijal- ) dm liance with legal requirements. APPLICANTS #.; t� DATE 12/24/2008 "° 1� a ` APPLICANT&AME(pr t) Patrick C�uillermefy 471 APPLICANTTITLE Director Environmental Health arz. & Safet