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Ak FIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form pet UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,A 111,IV,and IX below) 430. ® :: L NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430x. I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 Stan Boyett& Son Inc DBA Boyett Petroleum BUSINESS SITE ADDRESS 103 CITY 104, 1137 W Lathrop Rd I Manteca II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. TA0518495 Modern Welding ❑ 1.A STAND-ALONE TANK Complete one page for each ® 2.ONE IN A COMPARTMENTED UNIT compartment in the unit DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437 July 2009 12,000 2 III. TANK USE AND CONTENTS TANK USE S la.MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439x. ----._.._......._...._._.._....._...._._-..-_...._...._..........- -.....------._..__.....__.._.._......_.--.-----------........................._......................................._._ ._- -.. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440x. ...................................-_....---................................_.._.. __ .._ ------ -- NON-PETROLEUM:❑ 7.USED OIL............... ----0 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL S 2.DOUBLE WALL ❑ 95.UNKNOWN 443. ._......_._..__............................................................................................................................_.-_._..._............_........__...... .......... _..._.._.................................... --- ._._... _._......---.... ................._..-_---...... PRIMARY CONTAINMENT S 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER aaa. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT S I.STEEL S 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN S 99.OTHER(Specify): Steel Clad 445x. OVERFILL PREVENTION S 1.AUDIBLE&VISUAL ALARMS S 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 WALL S 2.DOUBLE WALL ❑ 99.OTHER 460. ..............................................................................---........................._......................................................................._....._._......_......_-._........................._._.__._....._.......__..._..._.... - -.-...-_..........W.._..__.._._.._..---------... -....._......._..............-- _.....__...-...... SYSTEM TYPE S 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 123 CCR§2636(a)(3)] 458. ----......................................................................................_..............._.....__._........................._.__ .._..__. _ -.-.-..- - --- --.........._.._..--_.._....-_..._-.._..-- PRIMARY CONTAINMENT ❑ I.STEEL S 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464x. Tiff ❑ L STEEL S 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ---....._...._....._......---- PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL S 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL S 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464ei. ............._.... ...............................................................__................................................_................................................................................--...._.._.....................---........................................................................................-----......_.._......................................_..__...............-......--------......................_._.___.__. 464f. VENT SECONDARY CONTAINMENT ❑ 1.STEEL S 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464B .................................... .................................................................................-....................................._.........................................._...........................-----...__..............................................................................._.....-----.............................-.......__...._....____....---.._..._........__......-......---- ..4�...._.. VR PRIMARY CONTAINMENT -❑ 1.STEEL _S 4 FIBERGLASS- ❑ 10.RIGID PLASTIC -❑ 90.NONE-❑ 99.OTHER(Specify): g464g ..........._. ...._......_..............__....-_.._............................_. 464i h. VR SECONDARY CONTAINMENT ❑ 1.STEEL S 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464h1. ...._----.................._._._--_--..............................- -----._....._...... _._ __ ...---- -.._......................._....-. -- ...._..._....---- __ -- -- VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL S 2.DOUBLE WALL ❑ 90.NONE 4�'' _..._ - --- __._._.-..._.._............................_.._................................-- ---�-_ _ -_-._-. --_<_ RISER PRIMARY CONTAINMENT S 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46q - ......... ......._ ..... ..........................................................................._..-.-...................._._...................._.-......_.._.._............__..--._........................_..._...._......................................-----------_.._.._.__ -- 464k. RISER SECONDARY CONTAINMENT ❑ 1.STEEL S 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464k1 _..__....-_.........................._.._..................---...-------.............................. _._._...-.-.-- _ -- ...._....------- 'INS -----.._.. ._.._............._._....._._ _....__........... FILL COMPONENTS INSTALLED S 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR S 4.CONTAINMENT SUMP a51e-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ L SINGLE WALL S 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE .... .......... ............................ CONSTRUCTION MATERIAL ❑ 1.STEEL S 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT S 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: 1 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 reqMrements. APPLICANT SIGNATURE DATE 6/29/2009 470 APPLICANT NAME(print) LC Services 471 APPLICANT TITLE Contractor arz UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org