BILLING 2009-2011 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,A 111,IK and IX below) 410. ❑ L NEW PERMIT ❑ 3.RENEWAL PERMIT ® S.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE EI 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: - 410,. PATE EXISTING UST DISCOVERED: 430t. I. FACILITY INFORMATION FACILITY ID R(Agency Use Only) BUSINESS NAME(Same as Faciltry Name or DBA-Doing Business As) 3. Tower Market#886 BUSINESS SITE ADDRESS 103 1 CITY 104, 1434 W. Yosemite Ave. Manteca,CA 95337 II. TANK DESCRIPTION TANKID4 432_ TANK MANUFACTURER433. TANK CONFIGURATION:THIS TANK IS 434 886-Reg Modem Welding ® I.A STAND-ALONE TANK Campletea epage r...6 DATE UST SYSTEM INSTALL 435. ❑ 2.ONE INA COMPARTMENTED UNIT compartment m the unit. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 4n. 1 O� 12,000 t III. TANK USE AND CONTENTS TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINAFUELING ❑ ie.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Inc.den Used oil) ❑ 5.EMERGENCY GENERATOR FUEL IHSC 025281.5(c)l ❑ 6.OTHER GENERATOR FUEL _❑ 95 UNKNOWN _ _ _ ❑ 99.OTHER(Specify)_ 439e CONTENTS PETROLEUM ® Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS -__ Cl S.PETROLEUM BLEND FUEL ❑ 9 OTHER PETROLEUM(Specify): 440a. NON PETROLEUM ❑ 7.USED OIL --- ---------- --- --- - ❑ ❑ 11.OTHER NON-PETROLEUM(Specify). 44ab. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ® I.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 aas ❑ 90_NONE ❑ 95.UNKNOWN_ ®99.OTHER(Specify): Steel Clad W/Fiberows reinforced plastic 445•. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 4sz ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT ENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER460. SYSTEM TYPE _ ® 1.PRESSURE [1 2.GRAVITY ,O3_CONVENTIONAL SUCTION_0_4 SATO SUCTION l 3 CCR§2636(.)(3)1 458 PRIMARY CONTAINMENT ❑ I _.STEEL ® 4.FIBERGLASS 0 S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90_NONE _____❑ 95 UNKNOWN ❑,99.OTHER(Specify)_ 464.. SECONDARY CONTAINMENT ❑ L STEEL ® 4 FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC <bib. ._.,..__....._._. ❑ 90-NONE ❑ 95 UNKNOWN ❑ 99.OTHER(Spec_N): 464a. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1 SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): )Mei _-_ ._._. ..__._..----- ____._.__ ._ .._.._...___ _.......... ......__. ..4dJf._ VENT SECONDARY CONTAINMENT ❑ I STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46w1 VR PRIMARY CON FAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464). VR SECONDARY CONTAINMENT ❑ I STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 466.1 ___._.____ _..._..._.... ------.__.. ._..____ ..._._. -a641... VENT PIPING TRANSITION SUMP TYPE ❑ i.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99.OTHER(Specify): 4 i. ...._....__._ .. __._ __..___.._.... _.___._...__._. ____... _._1 RISER SECONDARY CONTAINMENT ❑ I STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46a4k I. FILL COMPONENTS INSTALLED ® 1 SPILL BUCKET ® 3.STRIKPR PLATE7BOTTOM PROTECTOR ® 4,COMAINMENT SUMIP 4511<_ VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ I SINGLE WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90 NONE 469.. CONSTRUCTION MATERIAL ® I STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696. 469) VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 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 Informad0 ed herein is true, accurate,and in full compliancls,%ith legal requirements. APPLICANT SIGNATURE / DATE 11/1/2011 -1'+b 470_ / '-''ts APPLICANT NAME(print) Paul Chevalier 471. APPLICANT TITLE '472. Maintenance er ,.it. UPCF UST-B Rev.(12/2007)-1/2 wwvv.unidocs.org P r:e