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09/05/2008 18:41 9163751569 BROADBASE INC JIFFYL PAGE 03/03
<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK yr
<br /> OPERATING PERMIT APPLICATION-TANK INFORMATION one forni per UST)
<br /> TYPE OF ACTION (Chock Onc item Only, Foe art UST pe[manent closure or removal,complete Only this seLtim and Sections I,U,TU.IV,and IX below) 430
<br /> ® I.NF'W PERMIT Q 3.RFKFWAT.PERMIT ❑ 5.CHANGE OF INFORMATION
<br /> 6.TEMPORARY UST CLOSURE Q 7,UST PERMANENT CLOSURE ON SITE S.UST REMOVAL
<br /> DATE UST PERMANENTLY CLOSED; 170a I DATEEXISTINGUSTD15COVERED; d3%
<br /> L FACILITY INFORMATION
<br /> FACILITY ID#(Agency Use Only) ,
<br /> BUSINESS NAME(Same as FACILITY NAME,or DBA-Doing Business As)
<br /> JIFFY LUBE#598
<br /> BUSINESS SITE ADDRESS I03 CITY 1%4
<br /> 1130 N.MAIN ST. MANTECA
<br /> IL TANK DESCRIPTION
<br /> TANK IDR 432 TANK MANUFACTURER, 433 TANK CONHGUBATJON: THIS TANK IS 434
<br /> ®I,A STAND-ALONE TANx NNETANK
<br /> HOOVER CONTAINMENT INC. 02.0NEIINAOOMPARTMEN
<br /> TEOiPR.
<br /> G INP.a. 4 S.r MCh mtM1e mlil.
<br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY M GALLONS 436 NUMBER OF COMPARTMENTS M THE UNIT 437
<br /> 1959 500 1
<br /> III.TANK USE AND CONTENTS
<br /> TANK USE © 1a MOTOR VFMCI.F FUELING Q tb.MARINA FUELING 0 to.AVIATION FUELING 439
<br /> ❑ 3.CHEMICAL PRODUCTSTORAOE M 4.HAZARDOUS WASTE Nd.&t Undoi0 0 5.EMERGENCY GENERATOR FUEL.BISC 125291.58.)7
<br /> Q 6.OTHER GENERATOR FUEL Q 95.UNKNOWN Q 99,OTHERS i : 4.398
<br /> CONTENTS PETROLEUM: [I is RE(:ln,aR UNi,EADED Q Ie.M1DGRADEUNLEADED C7 Ib.PREMIUM UNLEADED 440
<br /> 0 3.DIP.SFL Q S.JET FURL ❑ 6.AVIATION GAS
<br /> Q &PETROLEUMBLENDFLIVI. Q 9.OTHER PETROLEUM i 440•
<br /> NON-PP.TROLEUM: 7.USED OIL Q t0.ETHANOL
<br /> 0 11,OTRMI NON•PETROLEUM S a6k
<br /> IV. TANK CONSTRUCTION
<br /> TYPEOFTANK ■ 1.SINGLE WALL 0 2DOUDLp WALL Q 95.UNKNOWN 44.1
<br /> PRIMARY CONTAINMENT ! 1.STEEL C3 3.FIBERGLASS ❑ 6,INTERNALBLADDER 484
<br /> Q 7.STEEL+INTSMALLINDIG Q 95.UNKNOWN 0 99.OT14EHt S i 444a
<br /> SECONDARY CONTAINMENT Q 1.STEEL. 3.FIBERGLASS Q 6.EXTERIOR MEMBRANE,LINER 0 7,JACKETED 445
<br /> 90.NONE 95,UNKNOWN 11 99.OTHBR , ci 445.
<br /> OVF.0.FR.L PREVENTION I.A[IDIBLP.R VISUAL ALARMS BALI,Fl_ 3.FILL TUBE SHUT-OFF VALVE 452.
<br /> 0 4,TANK MEETS REQUIREMENTS FOR IX,MPTTON FROM OVERFILL PREVENTION EQUIPMENT
<br /> V. PRODUCT/WASTE PIPING CONSTRUCTION
<br /> PIPING CONSTRUCTION Q 1.STOLE-WALLED Q 2,DOUBLE-WALLED E".OTHER 440
<br /> SYSTEM TYPE Q 1.PRESSURE M, 2,GRAVITY 01.CONVENTIONAL SUCTION Q 4.SAFE SUCTION P CCR zea . 3 459
<br /> PRIMARY CONTAINMENT V 1.STEEL 0 4,FIBERGLASS ❑ B.FLERIBL, 0 10.RIGID IM.ASTIC 464
<br /> Q 90.NONE 0 95,UNKNOWN 0 99.OT(L S i W.
<br /> SECONDARY CONTAINMENT Q 1.STEEL 0 4,FIBERGLASS R.FLPXIIR,P. 0 10.RIGID PLASTIC 4648
<br /> 0 9D.NONE 0 95.UNKNOWN Ig 99.OTHER(Spcuft 4m5
<br /> P7PDI(ITURBDE CONTAINMENT SUMP TYPE Q 1.SINGLE WALL ❑ 2,DOUBLE WALL M 90.NON, 444d
<br /> VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION
<br /> VENT PRIMARY CONTAINMENT U L STEEL U 4,FIBERGLASS Cl 10.RIGID PLASTIC -9-90-NONE Cl 99.OTHER(specify) 461.
<br /> VENT SECONDARY CONTAINMENT0 1,STEEL Ll 4.FIBERGLASS 0 10.RIGID PLASTIC E 90.NONE 0 99,OTW(SpmIfy) 46er
<br /> 4640
<br /> VR PRIMARY CONTAINMENT U 1.STEEL 0 4,F19FRGLASS 0 10.RIGID PLASTIC 90.NONE Iff 99.DTHER(spmiry) 464a
<br /> 044 i
<br /> VR SECONDARY CONTAINMENT 1.STEEL 4..FmBRG[ASS I0.RIOJD PLASTIC 9D,NONE 99.OTHER(sp..ify) 46411
<br /> 4Mkl
<br /> VENT PING TRANSTUGN SUMP TYPE I.SINOLE WALLCl 2,DOUBLE WALL 90,NONE 4nk.
<br /> RISER PRIMARY CONTAINMENT 1,STEEL 4.FIBERCLA55 U W.RIGIDPLASTIC m %.NONE. u 99.OTHER(Speew) 4mi
<br /> 46r1
<br /> RISER SECONDARY CONTAINMENT I.STEEL 0 4,FIBERGLASS ❑ IO,RIGID PLASTIC 90.NONE 0 99,OTHER(Spcdfy) 4wk
<br /> FILL COMPONENTS INSTALLED Q I.SPILL BUCKET 464k°
<br /> ❑ 3.STRIKER PLATG90TI'OM PROTECTOR 4.CONTAINMENT SUMP 451...
<br /> VIL UNDER DISPENSER CONTAINMENT(UDC)
<br /> CONSTRUCTION TYPE ❑ 1,SINGLE WALL Q 2.DOUBLE WALL 0 3.NO DISPENSERS ■ 9D,NONE 469.
<br /> CONSTRUCTION MATERIAL 0 I,STEEL 0 A.rraERGLASS 10.RIOID PLASTIC Q 99.OTHER i 469o-c
<br /> VIII. CORROSION PROTECTION
<br /> STEEL COMPONENT PROTECTION Q 2 SACRIFICIAL ANODE(S) C] 4,IMPRESSED CURRENT Cl 6.ISOLATION 449
<br /> IX. APPLICANT SIGNATURE
<br /> CERTIFICATION: I.rr fy that was LST system is compatible witb the hazardous substance stored and that the InftwmatIm provided herein is true,accurate,
<br /> and In full tom limine with I 1 ftnuiroaaestm.
<br /> APPLICANT SIONAT[IRE DATE 470.
<br /> APPLICANT NAME(prinl) 471' APPLICANT
<br /> h .E - Coozvt N Tort
<br /> UPCF I,;ST-R-112 Rev.(12/2007)
<br />
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