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io IZ�O AL F1ED PROGRAM CONSOLIDATED F 1� D�.Zlo�D UNDERGROUND STORAGE TANK l OPERATING PERMIT APPLICATION-TANK INFORMATIONdw (One form per US1') ITYPEOFACTION (Check one item only. ,For a USI'cloaure or removal,complele only this section and Sections 1,11,111,IV,,and IX below) 430. ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION [:1 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4300 DATE EXISTING UST DISCOVERED: 4301. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ :. BUS]Nr-SS NAME(Same as Facility Name or DBA-Doing Business As) 3 BUSINESS SITE ADDRESS 103• CITY 1137 W Lathrop Rd Manteca H. TANK DESCRIPTION TANK ID 4 432. TANK MANUFACTURER 433. TANK CONFIGURATION:TH1S TANK 1S 434, THOS 18496 Modern Welding 0 LA STAND-ALONE TANK Complete ens papa for each C1 2.ONE,IN A COMPARTMENTED UNIT compartment in rhe uni[. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. J 9 0•0°l 20,000 1 III. TANK USE AND CONTENTS TANK USE 0 la.MOTOR.VEHICLE FUELING ❑ lb�.M�AqR,,Iy�NA FUELING ❑ ]c.AVIATION FUELING d19• (] 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(lncludca Uscd Oil ❑ 5.EMERGENCY GENERATOR FUEL[H5C t25zai.5(c)] ____ ❑ 6,OTHER GENERATOR FUEL ❑ 95.UNKNOWN --_ Q 99.RT 439x. CONTENTS PETROLEUM: ® la.REGULAR UNLEADED M lc,MJDGRADE UNLEADED ❑ 1b.PREMIUM LINI.EADED 44407 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6,AVIATION GAS ❑ 8.PETROLEUM BLEND_FUEL ❑_ 9.OTHER PETROLEUM(S�e�i.fX2: 4404. NON-PETROLEUM-❑ 7.USED OIL y. ❑ IG.ETHANOL ❑ 11.OTHER NON-PETROLEUM S eci ): 440h. IV. TANK CONSTRUCTION _TYPE OF TANK_❑ 1.SINGLE WALL 10 2,DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ® L STEEL ❑ 3.FIBERGLASS 6.INTERNAL BLADDER ��- 444, ❑ 7.STEEL+INTERNAL LINING _ ❑ 95.UNKNOWN _❑ 99.OTHER(SDeci_fy SECONDARY CONTAINMENT 0 L STEEL - ®3.FIBERGLASS ❑ b.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. [1 90.NONE ❑ 95,UNKNOWN ®99.OTHER(Specify): Steel Clad 4454, 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 UIFMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING_CONSTRUCTION ❑ 1.SINGLE WALT. ® 2,DOUBLE WALL ❑ 99.OTHER 460. r SYSTEM TYPE_ _ ® 1.PRESSUPt _2.GRAVITY_ ❑ 3._CONVENTIONAL SUCTION El 4 SAFE SUCTION 3 2a 9'E3G(a)(3)] _458. PRIMARY CONTAINMENT El 1.STEEL M 4.FIBERGLASS Y❑ 8.FLEXMLEr� -��- T--[I10.RIGIDPLASTJC 464. - ---------�� ❑ 90.NONE_ Q 95,UNKNOWN_ ❑ 99.OTkwR($pacify); 4640. SECONDARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS 0 8,FLEXIBLE ❑ 10.RIGID PLASTIC - 464b. ❑ 90.NONE _❑ 95,UNKNOWN ❑ 99.OTHTR(Speafy); 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL 0 90.NONE 464d, VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT El1.STEEL ® 4.FIBEPOLASS E310.RIGID PLASTIC El 90.NONE El99.OTHER(Specify); 464c. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46611 VR PRIMARY CONTAINMENT _- LI 1.STEEL D9 A.FIBERGLASS Ll 10.RIGID PLASTIC El 90,NONE Ll99.OTHER(Specify): 4615. VR S_ECONDAR_Y_CONTAINMENT El 1.STEEL ® 4.FIBERGLASS C] 10.RIGID PLASTIC ❑ 90,NONE 99.OTHER(Specify): 464h. V_ENT_PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL p 90,NONE_ RISER PRIMARY CONTAINMENT - ® 1.STEEL p 4,FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4M RISER SECONDARY CONTAINMENT ❑ 1.STFEL ® 4.FIBERGLASS_ff 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): �v41 FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATEBOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 45ia-c-c. VII. UNDER DISPENSER CONTAINMENT (UDC). CONSTRUCTION TYPE -- El 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE` 469a. CONSTRUCTION MATERIAL Ij 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 40 VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT N 6.ISOLATION 445. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that tbis UST system Is compatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full compliance with legahmQuirements. APPLICANT SIGNATUREDATE 6/29/2009 470 APPLICANT NAME(print) LC Services 471' APPLICANT TITLE Contractor ,- 472. UPCF UST-11 Rev.(12/2007)-1/2 www.unidoes.org