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i UNIFIED PROGRAM CONSOLIDATED FORM # k UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) i TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 1,11,111,1V,and IX below) 430 € ❑ L 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: J30ti' I I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - BUSINESS NAME(Same as Facility Name orDBA-Doing Business As) 3. Nella Oil#487 DBA Olympian m 103. CITY 104. BUSINESS SITE ADDRESS I 983 Moffat Blvd Manteca IL TANK DESCRIPTION TANK[D 43'-- TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434. V n Modem Weldin ❑ t.A STAND-ALONE TANK Complete one page for each g ® 2.ONE IN A COMPARTMENTED UNIT compartment in the tmn. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT Orr. 1998 4,000 2 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439. F ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281 5(4)]] ] 6.OTHER GENERATOR FUEL 0-- - -- 95.UNKNOWN. ____....__....._0 99.OTHER(Specify)_ _._..__. .. ... ... 440. CONTENTS PETROLEUM: [Ila.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® lb.PREMIUM UNLEADED ❑ 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS 440a ❑ 8.PETROLEUM BLEND FUEL 9.OTHER PETROLEUM(Specify): ....•_.--__-.....___. NON PETROLEUM:❑ T USED OIL ❑ l0.ETHANOL El 11.OTHER NON-PETROLEUM(Specify): a4ob. IV. TANK CONSITRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 4a3. PRIMARY CONTAINMENT ® L STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER ! ❑ 7.STEEL+INTERNAL LINING __..._._ 95.UNKNOWN ❑ 99.OTHER(Specify) `.44a,..........._....._. 5. SECONDARY CONTAINMENT C] L STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 44I ❑ 90.NONE--- ❑.95.UNKNOWN (]99_OTHER(Specify)_ aa5a. i ...__...._._.__..._.__.......---•.--._-- - 452. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE t ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTIONWALL 4w .--_---._----.---.. __---.---...._._ ...t_SINGLE ® 2.DOUBLE WALL 99.OTHER _........_--......._--.-.---......._._-..__........._._..._.....__._.____....... SYSTEN58. [TYPE ___._...-®.1_PRESSURE.........._... 2c GRAVITY - - (]-3_CONVENTIONAL SUCTION (] 4.SAFE........SUCTION[23 CCR§2635(..)(3)1...-----'4--.- PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464_ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify).-__ 46aa ._...._...__.._...-_.-._--.._.-_'----.-__._...-----....._..__._..-.-.-----.._....__..-...._._.__..__.._.._.._._-_-- x646. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC a6ac ❑ 90.NONE [195.INKNOWN --0 99.OTHER(Specify): _.__.. ..---.......... PING/TURBINE CONTAINMENT SUMP TYPE ® L SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. PIi VI. VENT,VAPOR RECOVERY,;(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION I'I VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46jet.,_ -.._-.._.._..._....._....._...........-----------.......-........ _--_ _--___-._--- --....-____ -_---...--_•_.._.._.-__.-_.. aid i VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46411: ----------- VR PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify.: MAIL! VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h ! 664,. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE ._.. .. .... .... .._ .. _ .. ........................_.........---....."-"-•-----•'._.._-_......_.."'__.._.__-_ ...--------••----' ____.._.....---...._---._............_...__..._.._.........____:._..__..._._..........._.............._ ! RISER PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4"j: ...... .. _....__._....._.._._.._.-_._.......---....._ .--------...._._._.-._..--.-.-_.._.._.._......_._......._....__-..-----.......---...._-_.._.._---•_•--- '4b4k. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specif)): 46.41;1, .. ..--................ __......__...._._....._.............-___.._.._._......__-_.----........-._.........._----_-_-.-----.._..._._._._•----__.....-----.._.•...................._....__._............ 451a-c. fff( FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP VII UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® t SINGLE WALL -_--❑ 2.DOUBLE WALL ❑ 3_NO DISPENSERS ❑ 90 NONE 469.. i _.................__---_-._ ____..___._._.___.._.__.._._-..._._..._._ .__......... .... 4696. CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 99.OTHER(Specify)Poly 469c. F VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX. APPLICANT SIGNATURE I CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, - accurate It in full compliance vUh,legal requirements. $/18/2��9 4�0 APPLICANTSIGNATUR / DATE a =- APPLICANT NAME(print) 471' APPLICANT TITLEManager4r_ Amanda Appelt Environmental I 114!17 IlcT DD.... 1.1 MV.11 I .............:An..........