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M (0 t UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK 1 OPERATING PERMIT APPLICATION-TANK INFORMATION (0"e form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections L 17,111,IV,and IX belotiv) 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION I ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURFON SITE ❑ 8.UST REMOVAL i DATE UST PERMANENTLY CLOSED: 430a. DATE EXISTING UST DISCOVERED: 43ob I. FACILITY INFORMATION i FACILITY ID#(Agency Use Only) 3 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 ! Nella Oil#487 DBA Olympian 1 BUSINESS SITE ADDRESS 103 CITY T4. 983 Moffat Blvd Manteca 1 II. TANK DESCRIPTION ; � a33. 434. '• TANK ID# - /r 1 a3z. TANK MANUFACTURER TANK CONFIGURATION:THIS TANK IS V D -t-1 ❑ 1.A STAND-ALONE TANK Complete one page for each Modern Welding ® 2.ONE IN A COMPARTMENTED UNIT compatiment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437- 1998 8,000 2 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ ]c.AVIATION FUELING 439. j ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(includes Used Oil ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25291.5(c)) ----❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439a CONTENTS PETROLEUM: ® Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED aao. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV TANK CONSTRUCTION TYPE OF TANK 0 1.SINGLE WALL ® 2 DOUBLE WALL- [1 95.UNKNOWN __._._. . .__. 443. ---......_._..._.---__._.-_....__._. .___._-_.. .-- ' --- .__.... ....... .. __.......___......_-- PRIMARY CONTAINMENT ® I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER ; ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): aaaa. k( _.............____._......._ ----....._._..__......._...... ..__..._._.._.-.....---...................------._..........__..._- --....__ .._.- -' '- --'-'--..._..-'-'-' ...._... ............_..._..._.y45- SECONDARY CONTAINMENT 0 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): aasa -- -......._._......... ........... -.._..... _...._...-..........._......... OVERFILL PREVENTION - ❑ L AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION- _._.._0 I.SINGLE WALL ® 2 DOUBLE WALL--,❑ 99 OTHER _ - - -._-• __ ____ ... . ._.. aha t SYSTEM TYPE ® 1.PRESSURE Q 2 GRAVITY ❑ 3 CONVENTIONAL SUCTION-C] 4_SAFE SUCTION 123 CCR§2636(a)(3)) -456v _...*0'__N __-- ._._..-_.__.........._....._-_ .__.___._ PRIMARY_CO.------._.--._.NTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ lo.RIGID PLASTIC 464. C190.NONE [195.UNKNOWN ❑ 99.OTHER(Specify): 464a. j SECONDARY CONTAINMENT ❑ T.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC abab. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ------- ------'---- ---_--__._...._....__.......--.__ ._.___.- ---_--'-- -._.-_---_ -. -.........._ . PIPINGITURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL [:190.NONE 4644. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 1o.RIGID PLASTIC ❑ 90.NONE ❑ 99-OTHER(Specify): g6gej_ ..........-._.._._.._.__.._._......._�. _._--.-------... ----_-__.._-........__ 464f VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 36tlf1T .......... ...----'---.._.._.._.. ........' --.-__...._._...........-- .._...-- --'-- ---------___ --- -....--.._........_........._.. 464g. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46q&1: VR SECONDARY CONTAINMENT --❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC Y-® 90.NONE ❑ 99.OTHER(Specify): 464h 1, _._.._......._...._.....____....___..___._. __._....___.._.__..__. --'--.......__........_.........._______......_._..._.._..___..-__ -_�___... __._..-----.. __..____. __..-'-----'------....__................... ___.. VENT PIPING TRANSITION SUMP TYPE . . -..❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE qct' _..---_.....__._...._.-....__. _._.__-._.-._...- ................_........._._ ....._..........__. . ---- .......----'-•------' --- -'----....-.---•---.._.._._.__-'---...._..._..-.............. .-.___........_...__..__..__._._..;._.......__ RISER PRIMARY CONTAINMENT C] 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ ecif ( P y)�99.OTHER S 643' 46aj1. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): a6aki.:,,,. ._.___.....___..._......_.......__.._.._.____.___....._____...__....._.___...._.._.. .__........____......._._.......__..................-_...........__......._-__.._____-__•........--...-..-.--__._._-_.-.._......_.................._._._.._-.__......... 451a-c. �. FILL COMPONENTS INSTALLED ® I.SPILL BUCKET ® 3.STRIKERPLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP VII UNDER DISPENSER CONTAINMENT(UDC) ` I CONSTRUCTION TYPE ® 1 SINGLE WALL 0 2.DOUBLEWALL O 3 NO DISPENSERS- ❑ 90.NONE-__ - 469a f CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 99.OTHER(Specify)Poly 469b. a69c VIII. CORROSION.PROTECTION I STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 ! LY> 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 in full com Hance withijggal requirements. 470_ APPLICANT SIGNATUR DATE 8/18/2009 APPLICANT NAME(print) Amanda Appelt 471' APPLICANT TITLE Environmental Manager 47