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l/lzl)1 --iAo 5,Pj93 ? LA- l4 , UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One harm per USTI TYPE OF ACTION (Check one item only. Foran UST permanent closure or removal,complete only this section and Sections 1,H,III,IV,and IX below) [A I.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ R.UST REMOVAL DATE UST PERMANENTLY CLOSED: 13Oe DATE EXISTING UST DISC it :. 4 1 4306 I. FACILITY INFORMATION .:. 6 FACILITY ID 4(Agency Use Only) iq 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ARCO AM/PM Manteca BUSINESS SITE ADDRESS101 103 1904 Daniels Street anteca --NTAL HEALTH II.TANK DESCRIPTION nEPARINPENIT TANK ID 4 433 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 134 ❑1.A STAND-ALONE TANK 2B / �� Xerxes ®2.ONE IN A COMPARTMENTED UI.` Complete o.e popfor eachem in the Wit. T);UST SYSTEM INS LED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 stlmated Sept. GU� 10,000 Two Ill.TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING Q Ib.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CIIEMICALPKODUL7TSTORAGE ❑ 4.IIAZARDOUSWASI'E(Indmea U.d Dil) ❑ 5.EMERGENCY GENLRATOR FUEL IRSC§25181.51.)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 43% CONTENTS PETROLEUM: ❑ Is.REGULAR UNLEADED Q Ic.MIDGRADE UNLEADED Q Ib.PREMIUM UNLEADED 440 IX 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify); d4pi NON-PETROLEUM:❑ 7.USED OIL Ll 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 110b IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL US 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT U I.STEEL 15 3.FIBERGLASS ❑ 6.INTERNAL BLADDER ' ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (S ify): 414^ SECONDARY CONTAINMENT ❑ L STEEL 3 FIBERGLASS ❑ 6.EXTERIOR MFA§BRANE LINER ❑ 7,IACKETED a5 ❑ 90.NONE Q 95.UNKNOWN ❑99.OTHER(S ' a5a OVERFILL PREVENTION I.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SUM-OFF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 01 SINGLL-WALLED 2.DOUBLE-WALLED 1199.OTI[ER 460 SYSTEM TYPE I.PRESSURE ❑ 2.GRAVITY Q 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123 CC'R§3636(.K1)) 458 PRIMARY CONTAINMENT Q L STEEL IN 4.FIBERGLASS 0 S.FL RUBLE ❑ 10.RIGID PLASTIC 461 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464. SECONDARY CONTAINMENT ❑ I.STEEL Ug 4.FIBERGLASS Q S.FLEXIBLE ❑ 10.RIGID PLASTIC 4656 ❑ 90.NONE ❑ 95.UNKNOWN Q 99.OTHER(Specify): 464a PIPINGrrURBINL CONTAINMENT SUMP TYPE Q I.SINGLE WALL La 2.DOUBLE WALL ❑ 90.NONE 4Md VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT Q L STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC LI 90.NONE Q 99.OTHER(Specify) 4e1c 46fe1 VENT SECONDARY CONTAINMENT 0 I.STEF, CK 4.FIBERGLASS ❑ 10.RIGID PLASTIC D 90,NONE 0 99.OTHER(Specify) 4Nf 4mn VR PRIMARY CONTAINMENT ❑ I.STEEL 12 4.FIBERGLASS ❑ 10.RIGID PLASTIC Q 90.NONE ❑ 99.OTHER(Specify) 4NS 36jo VR SECONDARY CONTAINMENT L STEEL IN 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE Q 99.OTHER(Specify) 4644 464h1 VENT PIPING TRANSITION SUMP TYPE I.SINGLE WALL ' LE WALL 90.NONE 464`. RISER PRIMARY CONTAINMENT Q I.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE Q 99.OTHER(Specify) 4641 464'1 RISER SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464 464k1 FILL COMPONENTS INSTALLED I.SPILL BUCKET 3.STRIKER PLATEBOTTOM PROTECTOR N 4.CONTAINMENT SUMP 45I.+' VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TITE ❑ I.SINGLE WALL I9 2.DOUBLE WALL Q 3.NO DISPENSERS Q 90.NONE 469. CONSTRUCTIONMATERIAL Q I.STEEL W 4.FIBERGLASS Q 10.RIGID PLASTIC Q 99.OTHER(Specify) 46se, VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION Q 2.SACRIFICIAL ANODE(S) Q 4.IMPRESSED CURRENT Q 6.ISOLATION 448. UC. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the havardaus substance stored and that the information provided herein is true,accurate, and in full Cour Hance with legal re uiremenls. p 4W APPLICANT SIGNATURE DATE °31' 1 4n APPLICANT NA njeeAPPLICANT TITLE Rat Singh Owner UPCF UST-8-1/2 Rev.(I2/2007)