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AOL .FIED PROGRAM CONSOLIDATED FOIW UNDERGROUND STORAGE TANK 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,II,III,IV,and IX below) 430. ® 1.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: 430. 1 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) , Stan Boyett& Son Inc DBA Boyett Petroleum BUSINESS SITE ADDRESS 103. CITY 104 1137 W Lathrop Rd Manteca II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. TA0518496 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 20,000 I III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.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): 439a. ..................-..........................._......_.._._._............. ...............................................__...__.........._...._.........._.__...._...._........_................_............_..._....__..._._........................................._............................__.._-_ ...................... CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. ................................................................................................................................................................_........................_........................................__.._................ ........_._. ......._.._.._ _..................................................... _......_.._..............._.............. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.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): 444a. _..............................................._._._........_....... ...._._.......__..._.............................._.....................................----.................................._......__......._..._... _..__....... ..................... SECONDARY CONTAINMENT ® 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED aa5. ❑ 90.NONE ❑ 95.UNKNOWN ®99.OTHER(Specify): Steel Clad 445a ......................................................._............................................_......................__...._-__..................._.._._............. ...........-................. - OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIPNffiNT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUB_....................._LE WALL El 99, 460. ......................................................__...-----....._.......__._....._......................................................................................................._...._. ....................... SYSTEM TYPE ® I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458. --.................................................................................................................................................................__............_... ........_.........._____._... ------.._......._.........._......._..............................................._...----..__........._.................................................... PRIMARY CONTAINMENT ❑ l.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. ....................... ................................_................__.._...._.._........_..._................................................_..------..._....................................._..__._._. _......................................_....... SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ........_...._..._....__._......_...._......-.._....__....................._............_........_...----..__.........._........_....._. _................._.......__..__.............. PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE 4644, VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464. VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS El10.RIGID PLASTIC [190.NONE El 99.OTHER(Specify): 464e, .................................................................._.............................................................................._.._...................................---..............................__.._.._..._._.._........----.._.__..........................__................................................................................_._...- -...... ..................................................... VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): ....................................................................... ........................ VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46648. ..................................... ................................._. ........ ..............__......----...................._..............--------.._.._..................................................._...------------............_.............._........_.._.._ 464h. VR SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [I 10.RIGID PLASTIC [190.NONE El 99.OTHER(Specify): 464h1 _.._........._... VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE -...__._. -464i. ...-................................................................._............................................_............................................ ................................................---._............................_......_._................__._.._....._.................................--.......---. .._._.............._.........................................................................................___.._._..... .........;_... RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): qb j .....................................................................---......._............ .............................._....._.._................................................................................................_----------..........._.__..._..-._.__....__....................-..._...--------._.........._...._.._....................._............................. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 646 j ................ ........................................................................................................_....................................................................................................................................--�---------....-�----.._..---.._...._.................___.._...__..................................._.................................................. FILL COMPONENTS INSTALLED ® I.SPILL BUCKET El3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 451 a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a. .. ....................................._.............................................................................................................................................._................-----...........__.........................................................-..---.._._....._...._..............................._...._......._...._............_.............._.._.............................................._.................._... ................................................................................ CONSTRUCTION MATERIAL El 1.STEEL ® 4.FIBERGLASS [110.RIGID PLASTIC [14696.99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 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 r uirements. APPLICANT SIGNATURE F. DATE 6/29/2009 azo. APPLICANT NAME(print) LC Services 471. APPLICANT TITLE Contractor 472 1JPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org