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(0 2.2 vo '' IFIED PROGRAM CONSOLIDATED F �6 4 UNDERGROUND STORAGE TANK l 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 1,11,111,lY,and l.);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: 430a. I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) I. BUSINESS NAME(Same as Facility Name or D211-Doing Business As) 3. C f WcAT s NtAj 1TPCA # �1 BUSINESS SITE ADDRESS 105 CITY 104. 1137 W Lathrop Rd Manteca Ii. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. TA0518495 Modern Welding ❑ 1.A STAND-ALONS TANK Comyiete one pyre for each ® 2.ONE INA COMPARTMENTED UNIT compat ment in the uqi;, DATE UST SYSTEM INST'ALLE'D 435. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS IN THE UNIT 437 J±r2tl C6.I-0•OC1 o 00 2 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE PUFLING Q 1b.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(includes Used Oil) ❑ 5,EMERGENCY GENERATOR FUEL ItiSC 425281.5(c)l ® 3.DIESEL _ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a. 6,OTHER GENERATOR FUEL C! ___ _ CONTENTS PETROLEUM: ❑ la I1,EOULARUNLEADEDw6__'_ [� 1-,M[pGRADrs UNLEADED lb.PREMIUM UNLEADED 440. ❑ 5.JET FUEL LJ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL Elpeci .) 9.OTHER PETROLEUM(Sfy:-- 440s, ------- _.� . NON-PETROLEUM:❑ 7.USED OIL --' ~ 010.ETHANOL �] 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE O_F TANK ❑ 1,SINGLE WALL 0 7-DOUBLE WALL EI UNKNOWN 443 PRIMARY CONTAINMENT 0 1.STEEL - ❑ 3.FIBERGLASS E] 6.INTERNAL BLADDER'_ .~- � 444 ❑ 7.STEEL 4•INTERNAL LINING E] 95.UNKNOWN El99.OTHER S cifv: 444a. SECONDARY CONTAINMENT 0 1,STEEL .� ®3,FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER E] 7.JACKETED 445 ❑ 90.NONE ❑ 95,UNKNOWN ®99.OTHER(Specify)! Steel Ciad 445.. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS rR 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VAINe 452. ❑ 4.TAMC MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION H UIPNENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I,SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460 SYSTEM TYPE_ _0 i.PRESSURE ❑ 2.GRAVr]'Y _ 3,CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR 42636(a)(3)Iv 458. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE I] 10.RIGID PLASTIC 4&q _ 17 90,NONE _ d 95.UNKNOWN ❑ 99.OTHER(Specify_); 464_x. SECONDARY CONTAINMENT ❑ 1.STEEL Y ® 4.FIBERGLASS y EJ 8.FLEXIBLE ❑ 10,RIGID PLASTIC ❑ 90.NOME_ ❑ 95,UNKNOWN ❑ 99.OTHER(Specify): 4640 PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE Wql L 2.DOUBLE WALL ❑ 90.NONE aead. VI. VENT, VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS 0 10,RIGID PLASTIC ❑ 90.NONE ❑ 99.OTMR(Specify); »E-telel -- - -�,...-.... ---- --- -^--^^•.^ ._ VENT SECONDARY CONTAINMENT ❑ I.STEEL_® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE I] 99.OTHER(Specify): 4641. VR PRIMARY CONTAINMENT �❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90_NONI Ll 99.OTHER(Specify): 4 6 ------_ _ VR SECONDARY CONTAINMENT _❑ 1.STEEL M 4,1 15ERGLASS E] 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4Wj VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL M 2.DOUBLE WALL ❑ 90.NONE 4041 V_RISER PRIMARY_CONTAINMENT ® 1.STEEL El 4.FIBERGLASS ❑ 10.RIGID PLASTIC El 90.NONE 0 99.OTHER(Specify) Try a YRISER SECONDARY CONTAINMENT ❑ 1.STEEL 0 4,FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46� FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP d3" VII. UNDER DISPENSER CONTAINMENT.(UDC) CO_N_S_TR_UCTiON TYPE ❑ 1.SINGLE WALT, _-10 2.DOUBLE_WALL I] 3.NO DISPENSERS ❑ 90.NONE 469a. CONSTRUCTION MATERIAL - ❑ I.STEEL 0 4,FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99,OTfIER(Specify) w ~ -- -4390 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION 2.SACRIFICIAL ANODES ❑ 4,IMPRESSED CURRENT ® 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I 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 re 94Kements. APPLICANT SIGNATURE DATE 6/29/2009 470 APPLICANT NAME(print) LC Services 471. APPLICANT TITLE Contractor 472 vic UPCF UST-13 Rev.(12/2007).112 www.unidoes.org