BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK - OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,Ill,IV,and IX bclow) 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATfty �^ 2011 ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE [18.UST REMOVAL ��IINN DATE UST PERMANENTLY CLOSED: 4301 1 DATE EXISTING UST DISCOVERED: 430b ,I? I.,YACILITY INFORMATION FACILITY ID N(Agency Use Only) _ t BUSINESS NAME(Sante as FACILITY NAME or DBA-Doing Business As) 3 Arco Manteca BUSINESS SITE ADDRESS lo3 CITY 104 1711 E.Yosemite Ave Manteca II.TANK;DESCRIPTION TANK IDN �q3� TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 li-Regular�A4oSD " -lu9 N 1.A STAND-ALONE TANK v ❑2.ONE M A COMPARTMENTED UNIT. Com leu one oage for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 477 14976 Y :III:TANK'USE AND CONTOTS,* TANK USE E Ia.MOTOR VEHICLE FUELING ❑ ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.Cl IEMICAL 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): 4398 CONTENTS PETROLEUM: E 1 a.REGULAR UNLEADED ❑ 1 c.MIDGRADE UNLEADED ❑ 1 b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 4401 NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b TANIC'CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL E 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL E 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444,& SECONDARY CONTAINMENT ❑ I.STEEL E 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE, ❑ 95.UNKNOWN ❑%9 OTHER(Specify); 445a OVERFILL PREVENTION ® I.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOATIQ 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT Y..•ePROD:UC'T/, yASTE PIPII�G`CONSTtUCTION PIPING CONSTRUCTION C11.SINGLE-WALLED E 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEMTYPE E I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(1)(3)] 458 PRIMARY CONTAINMENT ❑ L STEEL E 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ W.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE E I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VL VENT,VAPOR`RECOVERY (VR)`pND USER/'FILL'PIPE PIPING:CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I.STF.EI, E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464c1 VENT SECONDARY CONTAINMENT ❑ L STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464f 464171 VR PRIMARY CONTAINMENT 1.STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 64g asi VR SECONDARY CONTAINMENT ❑ L STEEL E 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE. 99.OTHER(Specify) 464h 4601 VENT PIPING TRANSITION SUMP TYPE E 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464i RISER PRIMARY CON I AJNMEN 1 E L STEEL Lj 4.FIBERGLASS 0 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4" 464.1 RISER SECONDARY CONTAINMENT ❑ L STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED E 1.SPILL BUCKET 3.STRIKER PLATE/BOTTOM PROTECTOR E 4.CONTAINMENT SUMP 45la-c VII:?UNDER DISPENSER.CONTAINME,NT(UDC) CONSTRUCTION TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONF, 469a CONSTRUCTION MATERIAL ❑ L STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b c . *ye VIII.'CORROSION PROTECTION STEEL COMPONENT PROTECTION [12.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT E 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 requirements. 470. APPLICANT IGNA"PURE DATE to 4/15/2011 APPLICANT NAME(prin) 471" APPLICANT Trl'LE 472. Gurdeep Singh President UPCF UST-B-113 Rev.(12/2007)