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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK NOV 15 2016 OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) p TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1 11 III n `t H EALTI-'1 ® 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ S.CHANG ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL EPARTMEISIT DATE USCOVST PERMANENTLY CLOSED: N/A 430. DATE EXISTING UST DIERED: A 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 A6fuel luc. TRp5208t4 ( I4-f BUSINESS SITE ADDRESS 103 1 CITY /.� III.UII�04 1490 SOUTH MAIN STREET MANTECA V�J II.TANK DESCRIPTION TANKID# 432 TANK MANUFACTURER -131 TAN CONFIGURATION: TBISTANKIS 434 2A yJ CONTAINMENT SOLUTIONS ❑ LA STAND-ALONE TANK ®2.ONE M A COMPARTMENTED UNIT. Complete one page for each tom arimem in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 01/15/2017 8,000 2 III.TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ It.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil ❑ 5.EMERGENCY GENERATOR FUEL IHSC§25281.5(1)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439. CONTENTS PETROLEUM: ❑ In,REGULAR UNLEADED ❑ le.MIDGRADE UNLEADED ® 1b.PREMIUM UNLEADED J40 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440. NON-PETROLEUM: 7.USED OIL ❑ 10.ETHANOL ❑ 1 I.OTHER NON-PETROLEUM(Specify): 4401, IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99 OTHER (Specify): 444e SECONDARY CONTAINMENT ❑ 1.STEEL 913.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS El 2.BALL FLOAT 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.OTHER 460 SYSTEMTYPE ICJ 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(.X3)] 458 PRIMARY CONTAINMENT ❑ L STEEL KI 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464• SECONDARY CONTAINMENT ❑ L STEEL El 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASTIC 4641, ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4641 PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL IN 2.DOUBLE WALL ❑ 90.NONE 464d V1.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464¢1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) i64f 461fl VR PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4648 464 1 VR SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4646 464hl VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL IN 2.DOUBLE WALL ❑ 90.NONE 4641. RISER PRIMARY CONTAINMENT ❑ 1.STEEL ZI 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464, 464 1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FBERGLASS ❑ 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 VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ L SINGLE WALL Pq 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ I.STEEL IN 4.FIBERGLASS ❑ I0.RIGID PLASTIC ❑ 99.OTHER(Specify) 4691 c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that thisT system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with I.Vgal requigements. APPLICANT SIGNATURE DATE 470. Il�(T/l6 APPLICANT NAME(p t) (ANNIE)GU R _. N ... APPLICANT TITLE 472, YREfr E UPCF UST-B-12 Rev.(12/2007)