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► ARCO Fac,.,,,,'NGG 6020 0 W,10 #3 84�� '� UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK IN ORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and SI' ns 1,11,111,IV,and IX below) 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT (r5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 4306. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) I BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. ARCO AM/PM BUSINESS SITE ADDRESS 103. CITY 104. 1711 East Yosemite Boulevard Manteca II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433• TA1N CONFIGURATION:THIS TANK IS 434. 4 '4 ,5> Containment solutions 1.A STAND-ALONE TANK Complete one page for each [32.ONE INA COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436• NUMBER OF COMPARTMENTS IN THE UNIT 437. 10K One (1) III. TANK USE AND CONTENTS TANK USE 9 la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.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: �r la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED E3lb.PREMIUM UNLEADED 440• ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440x. NON-PETROLEUM:❑ 7.USED 61-L - ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ay.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ❑ 1.STEEL Iff 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444• ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER Specify): 444L SECONDARY CONTAINMENT ❑ 1.STEEL 19 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. _❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445& OVERFILL PREVENTION M 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL C9 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE _ 1.PRESSURE 13,?.GRAVITY [33.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(.)(3)] 458. PRIMARY CONTAINMENT ❑ 1.STEEL 9 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464• _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify):_ 464& SECONDARY CONTAINMENT ❑ L STEEL U4.FIBERGLASS ❑ 8.FLEX03LE ❑ 10.RIGID PLASTIC 464b. - --0 90.NONE 0 95.UNKNOWN 0 99.OTHER(Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 90.NONE 4644 VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT [31.STEEL W4.FIBERGLASS ❑ 10.RIGID PLASTIC El90.NONE [399.OTHER(Specify): 464c 1. fie• VENT SECONDARY CONTAINMENT ❑ L STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4644fI. VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC If 90.NONE ❑ 99.OTHER(Specify): gj. -- - -- VR SECONDARY CONTAINMENT [31.STEEL [34.FIBERGLASS [310.RIGID PLASTIC W90.NONE ❑ 99.OTHER(Specify): 464hl. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL S(2.DOUBLE WALL ❑ 90.NONE 464'' RISER PRIMARY CONTAINMENT ❑ L STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 44"j. RISER SECONDARY CONTAINMENT [3L STEEL 4.FIBERGLASS [I10.RIGIDPLASTIC ❑ 90.NONE [399.OTHER(Specify): 4664k1. FILL COMPONENTS INSTALLED Eff 1.SPILL BUCKET W 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL [:13.NO DISPENSERS ❑ 90.NONE 469a. -._.-_.. _.._. _ ... - -- 469b. CONSTRUCTION MATERIAL ❑ 1.STEEL Ej(4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 46%. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION N/A 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. APPLICANT SIGNATURE _ DATE 470. APPLICANT NAME(print) Ruth Ha 471' APPLICA TITL Env. Compliance Special i s C2 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org