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Ir ��1• E UNIFIED PROGRAM CONSOLIDATED FORM j UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,11,111,IV,and IX below) 430 ❑ 1.NEW PERMIT N 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL f DATE UST PERMANENTLY CLOSED: 430a. I DATE EXISTING UST DISCOVERED: 430b i I. FACILITY INFORMATION I. f FACILITY ID#(Agency Use Only) - - BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. ! E Nella Oil#487 DBA Olympian BUSINESS SITE ADDRESS 103 TaTy 04 E 983 Moffat Blvd Manteca II. TANK DESCRIPTION TANK ID# "� 432. TANK MANUFACTURER 433' TANK CONFIGURATION:THIS TANK IS 434' ® 1.A STAND-ALONE TANK Complete one page for each 1 Modern Welding ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436- NUMBER OF COMPARTMENTS IN THE UNIT 437 1998 12,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HSC¢25291.5(c)] � 6 OTHER GENERATOR FUEL --- -E] 95.UNKNOWN 0_99.OTHER -.-.._....._.__._...-._...-__.............._..._ . ..... i39a. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ 7c.MIDGRADE UNLEADED C1 Ib_PREMIUM UNLEADED 4ao. N 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 440a ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): NON-PETROLEUM:❑ 7.USED OIL ❑ t0.ETHANOL ❑ I(.OTHER NON-PETROLEUM(Specify); 44ob. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL N 7 DOUBLE WALL ❑ 95.UNKNOWN 44. PRIMARY CONTAINMENT N L STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER ' --_--..--. _•----. ..__.__._. ._._... _....__[:J_7.STEEL-INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify). -444a .. .. .... . ...... ... .. ... 445. SECONDARY CONTAINMENT � 1.STEEL N 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED ❑ 9_0_.NONE _ _ ❑ 95.UNKNOWN N ❑9_9.OTHER(Specify): 4450. -- -..................... OVERFILL PREVENTION ❑ I.AUDIBLE&VISUAL ALARMS ❑ 2.13ALLFLOAT N 3.FILL TUBE SHUT-OFF VALVE 052. ❑ 4.TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL_ 0 99.OTHER - 460. I SYSTEM TYPE _.,...,.--®,1.PRESSURE -(] 2.GRAVITY 3:CONVENTIONAL SUCTION--� 4.SAFE S.... (23 CCR g42616(a)(3)] -- i PRIMARY CONTAINMENT 1.STEEL 04 FIBERGLASS ❑ 8.FLEXIBLE ❑ lo.RIGID PLASTIC E ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a' 460 _ _ _ _ __. ---'-------- -..--.._..._._ _- _._.... - ..........__.. SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. _ ❑ 90.NONE _ _❑ 95.UNKNOWN _❑ 99.OTHER(Specify):- 464c. f PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL- ❑ 2.DOUBLE WALL ❑ 90.NONE 4 ' VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464, VENT PRIMARY CONTAINMENT El 1.STEEL N 4.FIBERGLASS ❑ Id.RIGID PLASTIC ❑ 90.NO ❑ 99.OTHER(Specify): 464e1c _- 1 .._.__._.--._.._....__.......-.._._.---............_.___.. _................___....__. .. _.__.._............-__.........._--..___..__"_.--------'--._..__.._._-._..__.-'-----_._-_.__._.__..__._........_.__.._....----......._-_.... 464E ... .._...._ i VENT SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): ._...__._.........._.._.......__..........._..__....__.._...---._.......__..__...__...................__._....__.-..-__._._._-'--_..._..._...._._....._--....__..__-.._.._..........._.._..._._........._.............................--....---_...------._..._....-----'---- 4649. VR PRIMARY CONTAINMENT ❑ I.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 460-g1; ! ......._.......___-____..-_---_---.__..---_...._---._......__._......--__--_._....__.._...._.._...__._........ -__-.___ VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): abahl._- ._._-..-'---._.._......_.......-..---__......_.__....__.__-__...._.___.._._.__.,.-.__..___....---......_....----_._--_-""- __._..._.__._..._.........................._........_........ _ -4641. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL N 90.NONE s -.........._......__............................._.....-'--- -....- -'--..... ......... - --.-.- ..-_-.__..... -..._.. -'- -...._ -' -....._ - ...... '_ _..._........---......._-..........-- RISER PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): a6ajl,.•,. --.......__._....----.._............._--'---._.-_._-•-----......-_____---._...----...:........._..------•-............_-.._._..-_-._-.......__ ._..--'--...__._.._----------........--..._..----..._.._...__.__-_- 464L RISER SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ ]0.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): 464k t. --' -....................._-------._._..... .._.. -- _......_.......- -- - -. -.- _-'---..._._.....- __._.....-----...__...._.........._.....--'--'- - C_ .. ..._ 451a-c. FILL COMPONENTS INSTALLED N 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP � f VII. UNDER DISPENSER CONTAINMENT(UDC) ! CONSTRUCTION TYPE N 1.SINGLE WALL_ _ -__-[3 2_DOUBLE WALL Ll3.NO DISPENSERS ❑ 90. ONE 4C93 CONSTRUCTION MATERIAL [31.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 99.OTHER(Specify)Poly 469c. { VIII. CORROSION.PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 4.IMPRESSED CURRENT ❑ 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,aV4 in full compliance with legal requirements. 470 APPLICANT SIGNATURE DATE 8/18/2009 47` APPLICANT NAME(print) Amanda Appelt 471 APPLICANT TITLE Environmental Manager r