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CI lo�Zz���l <br /> Adk <br /> IFIED PROGRAM CONSOLIDATED Ffflwl (B <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PC'17MIT APPLICATION-TANK INFORMATION (Otte form per UST) <br /> TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,A 117,IV,and Ix below) 470 <br /> ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT L] 5.CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 4304• DATE EXISTING UST DISCOVERED: 4306. <br /> I. FACILITYINFORMATION <br /> FACILITY ID#(Agency Use Only) _ 1_ <br /> BUSINESS NAME(Same as Facility Name or DB,4-Doing Business As) 3. <br /> n �tL' -MS Ma SCA -4 2�� <br /> BUSINESS SITE ADDRESS los. CITY ICA <br /> 1137 W Lathrop Rd I Manteca <br /> TT. TANK DESCRIPTION <br /> TANIC ID# 432• TANK MANUFACTURER 433• TANK CONFIGURATION:THIS TANK IS 434• <br /> TAOS18494 Modem Welding ❑ 1,A STAND-ALONE TANK Corn pleteonePage <br /> lbreach <br /> 2.ONE IN A COMPARTMENTED UNIT comp4rtmrne in the unit. <br /> DATE UST SYSTEM INSTALLED 435• TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437 <br /> 48-,W 1 OO'D Z <br /> III. TANK USE AND CONTENTS <br /> TANK USE ❑ la,MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ it,AVIATION FUELING 439. <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.IIAZA RDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL(tisc 125281 5(c)) <br /> ❑ 6,OTHER GENERATOR FUEL ❑ 95.UNKNOWN _❑ 99,OTHER(Specify): 4394. <br /> CONTENTS PETROLEUM; j 1 a.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ® lb,PR.EMrUM UNLEADED 440.^ <br /> 3.DIESEL ❑ 5,JET FUEL ❑ 6.AVIATION GAS <br /> 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(S2ecifyL 4401 <br /> NON-PETROLEUM:❑ 7.USED OIL ❑X10.RTRANOL <br /> © 11.OTHER NON.PETROLEUM S eci : 4406. <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL q 2,DOUBLE WALL ❑ 95,UNKNOWN 443. <br /> PRIMARY CONTAINMENT M 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER <br /> 0 7.ST_E_EL_+INTERNAL LINING ❑ 95.UNKNOWN ❑ 9_9_21HERSSpecify): 4449, <br /> SECONDARY CONTAINMENT M 1,STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7,JACKETED 445 <br /> _ ❑ 90.NONE ❑ 95.UNKNOWN ®99.OT82R(Sp_w_ify): Steel Clad 445x. <br /> OVERFILL PREVENTION -ISS 1,AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT ❑ 3.FI LL TUBE SHUT-OFF VALVE �a52 <br /> tj 4.TANK MEETS Rh UTREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIPNIENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION TION _❑ 1.SINGLE WALL IM 2,DOUBLE WALL (� 99.OTHER _ _ 4307 <br /> SYSTEM TYPE _ _ ® 1.PRESSURE-❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION 0_4.SAFE S_UCTION�23 Ccji26L a 3L__ 458_ <br /> PRIMARY CONTAINMENT ❑ 1.STEEL _ ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10,RIGID PLASTIC 464. <br /> ❑ 90,NONE _❑ 95,UNKNOWN ❑ 99,OTHER f}Specify): _ 4649. <br /> SECONDARY CONTAINWNT ❑ 1.STEEL M 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99,OTHER(Specify); 4640. <br /> PIPfNWURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE 464d. <br /> VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ 1,STEEL ® 4.FIBERGLASS [I10.RIOW PLASTIC [190.NONE [399.OTHER(Specify); 4A6 j <br /> T SEC <br /> VENON6aR CONTAINMENT ❑ 1.STEEL 19 4.FJ)3ERGLASS_ ❑ 10.RIGID PLASTIC ❑ 90.NONE d 99.OTHER(Specify): 4E r <br /> VR PRIMARY CONTAINMENT ❑ 1,STEEL -EJF-4.FtBERGLASS ❑ 10,RIGID PLASTIC 90,NONE © 99.OTHER(Specify); era & <br /> VR SECONDARY CONTAINMENT ❑ 1.STEEL-Q.4.FIBERGLASS ❑ 10,RIGID PLASTIC 90,NONE ❑ 99.OTHER(Specify); 464 . <br /> ___ 4Lrlhl. <br /> VENT_PIP_ING TRANSITION_SUMP TYPE ❑ 1,SINGLE WALT. ® 2.DOUBLE WALL Wy❑ 90_NO_NL <br /> R1SER PRIMARY CONTAINMENT p 1,STEEL ❑ 4,FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90-NONE <br /> _ _ [] 99.OTHER(Specify); 46411 <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ l0.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHF-P,(Specify): 46ak� <br /> FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 4514-c- <br /> VII. UNDER DISPENSER CONTAINMENT(UDC) <br /> _CONSTRUCTION TYPE ❑ 1.SINGLE WALL ® 2,DOUBLE WALL_ ❑ 3.NODISPENSERS ❑ 9_0.NONE 469a. <br /> CONSTRUCTION MATERIAL ❑ I.STEEL ® 4.FIBaRGLASS. ❑ 10,RIGIDPLASTIC ❑ 99.OTHER(Specify) 4696. <br /> 4690. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4,IMPRESSED CURRENT ® 6.ISOLATION 448. <br /> IX. APPLICANT SIGNATURE ' <br /> CERTIFICATION, I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, <br /> accurate,and in full compliance with legal requitwnents. <br /> APPLICANT SIGNATURE DATE 6/29/2009 470. <br /> APPLICANT NAME(print) C Services 471' APPLICANT TITLE Contractor a7z. <br /> UPCF UST-B Rev_(12)2007)-V2 www.unidocs.org <br />