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*IED PROGRAM CONSOLIDATED FO S t I IyQ UNDERGROUNDSTORAGETANK Iy4I I 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, II, III, IV, and IX below) 430 ❑ I. NEW PERMIT ❑ 3. RENEWAL PERMIT 0 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 43oa DATE EXISTING UST DISCOVERED: 430b r4 ` r, ,°, <3�iII ,FACILITY?INFORMATION`,3 r.#3 FACILITY ID # (Agency Use Only) 4"<' l F, BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Stockton Gas BUSINESS SITE ADDRESS 103 CITY 104 322 South Center Street Stockton 9 e �^ ✓ "�L k rfi A,� i,r F < k]h.,yt S S 7'r . & ..Y +£F z Ii?. f's2tate r II:TANK�DESCRIPTION a ,x f. .F.. TANK ID # 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 2 -Premium` ® 1. A STAND-ALONE TANK �� X [:12. 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 437 0 D 14,976 1; - , ', irrtrkr'�' TANK USE AND CONTENTS ,,. r.� k, TANK USE ® la. MOTOR VEHICLE FUELING L1lb. MARINA FUELING ❑ lc. AVIATION FUELING 439 ❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 5. EMERGENCY GENERATOR FUEL [HSC §25281.5(c)] ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ Ic. MIDGRADE UNLEADED ® lb. PREMIUM UNLEADED 440 ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ❑ 8. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (Specify): 440a NON -PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL ❑ 11. OTHER NON -PETROLEUM (Specify): 440b <A �s " 3ti IY TANK CONSTRUCTION I �r V 3t4t ' f S s" .1J, ! EL TYPE OF TANK ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 95. UNKNOWN 443 PRIMARY CONTAINMENT ❑ L STEEL ® 3. FIBERGLASS ❑ 6. INTERNAL BLADDER 444 ❑ 7. STEEL+ INTERNAL LINING ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1. STEEL ® 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 452. ❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT t ,t PRODUCT / WASTE PIPING°;CONSTRUCTION u e�°ria, ,'; ,' ., PIPING CONSTRUCTION ❑ 1. SINGLE -WALLED ® 2. DOUBLE -WALLED [199. 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 ❑ 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 ® 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 464d RISER'/,;FILL PIPE PIPING CONSTRUCTION YI.'VENT,VAPOR:RECOVERY.(VR)'AND VENT PRIMARY CONTAINMENT ❑ L 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) 464f 464n VR PRIMARY CONTAINMENT ❑ L STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 4646 464 I VR SECONDARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464h 464h VENT PIPING TRANSITION SUMP TYPE ® 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 464'. RISER PRIMARY CONTAINMENT ® 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464] 464'1 RISER SECONDARY CONTAINMENT ❑ L STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify) 464k 464k1 FILL COMPONENTS INSTALLED ® I. SPILL BUCKET ® 3. STRIKER PLATE/BOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 45la-c {c� e74�t��VII<UNDERDISPENSER'CONTAINMENT,([TDC�,�t-NPt .'t �; ... CONSTRUCTION TYPE ® 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469a CONSTRUCTION MATERIAL ❑ L STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC [1 99. 4 OTHER (Specify) 69b•c y, A. - _ . - L x .. XVIII �; CORROSION PROTECTION, STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT ® 6. ISOLATION 448. APOIL' ICANT+SIGNATURES ' r intL'K ,. I u CERTIFICATION: I 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. PLICA SIGNAT DATE: 2/28/2011 470. APPLICANT NAME (print) 471. APPLICANT TITLE 472. Amar' it Rai Secretary UPCF UST -B - 2/2 Rev. (12/2007)