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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (one tnnn per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,HI,W.mid I\below) 430 (� 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF LNFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ R.UST REMOVAL DATE UST PERMANENTLY CLOSED: as I DATE EXISTING UST DISCOVERED: 410° I. FACILITY INFORMATION FACILITY ID k(dgenry Use Only) - ii BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO AM/PM Manteca MAY 3 Y Z017 BUSINESS SITE ADDRESS 133 1904 Daniels Streetanteca a II.TANK DESCRIPTIONI F L HEALTH TANK IDH 431 TANK MANUFACTURER 433 TANK CONFIGURATIO IS TAN-KIS C3 434 '2A / ,'(�J Xerxes ❑ L A STAND-ALONE TANK ULPAR I IVIEIVT l ®2.ONE IN A COMPARTMENTED VNT. p- g I�gTpy Itte one Lear Fn caheo nanem in 3ltuniL AT naffed Se M 2017 LED 435 TANK CAPAC17Y IN GALLONS 4'-6 NUMBER OF COMPARTMENTS IN THE UNIT 431 P 12,000 TWO M.TANK USE AND CONTENTS TANK USE M Ia.MOTOR VEHICLE FUELING ❑ I It.MARINA FUELING ❑ Ic.AV1ATIONFUELLNG 139 ❑ 3.CHEMICALPRODUCTSTORAGE ❑ 4.HAZARDOUS WASTE(Incladn Used Oin ❑ 5.EMERGENCY GENERATOR FULL IHSc j2n8L5(c)I ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 43% CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ❑ I,MIDGRADEUNLEADED I b.PREMIUM UNLEADED 446 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OnIERPETROLEUM (S cif : aW NON-PETROLFUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS ecif is u3c IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL 0 2.DOUBLE WALL ❑ 95.UNKNOWN 43 PRIMARY CONTAINMENT ❑ 1 STEEL n 3.FIBERGI.ASS 06.INTERNAL BL ADDER i44 ❑ 7.STEEL,INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): tua SECONDARY CONTAINMENT ❑ 1.STEEL 29 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 443 90 NONE ❑ 95.UNKNOWN ❑99.O'"ITER(S ei ): u5a OVERFILL PREVENTION I.AUDIBLE&VISUAL ALARMS 02.BALLFLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED 2.DOUBLE-WALLED [199.01111Ed 463 SYSTEM TYPE1.PRESSURE ❑ 2.GRAVITY [13.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123 CM§2636(a)(3)] 43B PRIMARY CONTAINMENT C3 I.STEEL IN 4.FIBERGLASS [1-9.FLERiBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4&a SECONDARY CONTAINMENT ❑ 1.STEEL IN 4.FIBERGLASS ❑ 8.rLEXMLB ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN 0 " 0 99.OTNER(Spce" ): 164c PIPINGgURBINE CONTAINMEN'TSUMP TYPE ❑ I.SINGLE WALL T2BLEWALL ❑ 90.NONE 4614 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 0 L STEEL IN 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464c 441 VENT SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RICID PLASTIC 90.NONE 99.OTHER(Speeify) 14n 46 n VR PRIMARY CONTAINMENT El I.STEEL IR J.FIBERGLASS El 10,RIGID PLASTIC 0 90.NONE 0 W.OTHER(Specify) 4619 64 I \'R SECONDARY CONTAINMENT L STEEL Ca J.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 464n 6461 VENT PIPING TRANSITION SUMP TYPE 0 I.SINGLE WALL IM 2.DOUBLE WALL 90.NONE 161i. RISER PRIMARY CONTAINMENT ❑ I.STEEL IN 4.FIBERGLASS U 10.RIGID PLASTIC U 90.NONE ❑ 99.OTHER(Specify) 464j 464'I RISER SECONDARY CONTAINMENT El I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC O 90.NONE ❑ 99.OTHER(Specify) 464k 46uA FILL COMPONENTS INSTALLED L SPILL BUCKET 3.STRIKER PLATFIBOTTOM PROTECTOR M 4.CONTAINMETT SUMP 451. VIL UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL M 2.DOABLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469+ CONSTRUCTION MATERIAL ❑ 1.STEEL Ca 4.FIBERGLASS ❑ I0.RIGID PLASTIC ❑ 99.OTHER(Specify) 469bc VIM CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION T4s. 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, and in full compliance with legal requirements. APPLI SIG P, DATE OS A" APPLICANT NAME tin411. APPLICANT TITLE PQ Ran)eet Singh Owner UPCF UST-B-1/2 Rev.(12/2007)