COMPLIANCE INFO_2010-2015 - 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 ate item only. For a UST closure or reto oval, complete ontp This section 017=717'.77 11.111, IV, and LK belou) 430. ❑ 1. NEW PERMIT ® 3. RENEWAL PERMIT ❑ S. CHANGE OF INFORMATION 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ S. UST REMOVAL 430b DATE UST PERMANENTLY CLOSED: 43U3 DATE EXISTING UST DISCOVERED: 1. FACILITY INFORMATION l FACILITY ID N (Agency Use Oni)J 3. BUSINESS NAME (.Same as Facility Naine or DBA - Doing Business As) Flyers #487 uld. 103. BUSINESS Sl'fF. ADDRESS CITY 983 Moffat Blvd Manteca II. TANI4; DESCRIPTION TANK Ip# a3z. TANK MANUFACTURER 433• 'TANK CONFIGURATION: THIS TANK IS 434. ®l. A STAND-ALONE TANK Convfete one page for each 1 Modern Welding ❑ 2. ONE IN A COMPARTMENTED UNIT-nV--nt in The unit. 435. 436. 437, PATE UST SYSTEM INSTALLED TANK CAPACITY [N GALLONS NUMBER OF COMPARTMENTS IN'i'l IE UNIT 1998 12,000 III. TANK USE AND CONTENTS TANK USE ®la. rrtOTOR VEHICLE FUELING ❑ Ib. MARINA FUELING ❑ 1c. AVIATION FUELING 439' ❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 5. EMERGENCY GENERATOR FUEL InSC §2528LA01 4193._ ❑ & OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99.OTIIF.R (Specify}: 440. CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ ic. �tIDGRADF. UNLEADED ❑ kb. PREh11UkI UNLEADED ❑ 6. AVIATION GAS ® 3. DIESEL ❑ S. JET FUEL 4494 ❑ S. PETROLEUM BLEND FUEL C]9.OTHER PETROLEUM (Specify): -- NON-PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL 440b. ❑ 11.OTHER NON-PETROLEUM cify): IV. TANK CONSTRUCTION 443. TYPE OF TANK D I. SINGLE WALL ® 2. DOUBLE WALL Q 95. UNKNOWN - 444 _ PRIMARY CONTAINNIENT ® 1. STEEL ❑ 3. FIBERGLASS [1 6. INTERNAL BLADDER 444a C]95. UNKNOWN t-199.OT_HF.R (Specify): ❑ 7. STEEL+ INTERNAL. LINING tis. SECONDARY CONTAINMENT ❑ 1. STEEL M 3. FIBERGLASS E36. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445a ❑ 90. NONE _ 13pec 95. UNKNOWN ❑ 99. OTHER (Specify): 452 OVERFILL PREVENTION ❑ L AUDIBLF. & VISUAL. ALARMS ❑ 2. BALL FLOAT ® 3. FILL TUBE SHUT-OFF VALVE ❑ 4. TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION 460. Pip CONSTRUCTION ❑ I. SINGLE WALL. ® 2. DOUBLE WALL ❑ 99. OTHER 454 El 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑ 4. SAPS SUCTION 123 CCR §2636(a}(3)J SYSTEM TYPE N 1. PRESSURE 404 PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ S. FLEXIBLE ❑ 10. RIGID PLASTIC 4641. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.OTHER (Specify}: 464e' SECONDARY CONTAINMENT [3L. STEEL ® 4. FIBERGLASS ❑ S. FLEXIBLE ❑ t0. RIGID PLASTIC 464c. ❑ 90. NONE E]95. UNKNOWN ❑ 99.OTHF:R (Specify): 4644 PIPING/TURBINE CONTAINMENT SUNIP TYPE ® L SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION VI. VENT, 464e VENT PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS S 90 OTHER (Sgeeify): 464cl:.._ 464f VENT SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS I PLA S,S 9tj NONE OTIiER (Specify): 64g VR PRIMARY CONTAINMENT ❑ 1. STEEL 4. P)BEROLASS )D PLASTIC ❑ 90. NONE ❑ 99.OTILF.R (Specify}: 464 1. VR SECONDARY CONTAINMENT ❑ I. STEEL. ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTI ®_ `t1Q ONE Q 99. OTtIER (Specify): 4, VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBL 4LL" ONE sbi RISER PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS Q 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.0THER (Specify): t bj RISER SECONDARY CONTAINMENT ❑ 1. Sum, Q 4. FIBERGLASS C \l -4 NO111Ea ❑1 OTFIER (SpcciQ'): a6jfcl. 4514-c. _ _ 3 f INMENT SUMP FILL CO�LPONL'N'TS 1NS'TALI.F.D _ ®l. SPILL. BUCKET ®. STRI - ❑ 4. CONTA VII. UNDER DISPENSER CONS T (UDC) 4691. CONSTRUCTION TYPE ® 1. SINGLE WALL Q 2. DOUBLE WALL 13 3.NO DISPENSERS ❑ 90. NONE �. _ CONSTRUCTION MATERIAL ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 99. OTHER (Specify) POIy 4690. VIII. CORROSION PROTECTION 440. 13STEEL COMPONENT PROTECTION 2. SACRIFICIAL ANODES ❑ 4. IMPRESSED CURRENT [36. ISOLATION 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, accurst din full com dianc h !e nI rc uirements. 470 APPLICANT SIGNATUI DATE l0/4/1 l 472. a7i' APPLICANT NAME (print) ALllanda Appelt APPLICANT TITLE Environmental Manager UPCF UST -I3 Rev. (12/2007)-1/2 www.uaidocs-01.9