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E 11 UNIFIED PROGRAM CONSOLIDATED FORA'I UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -TANK INFORMATION (One form per UST) TYPE OF ACTION (Check ore /tent only. For a US1'closure or removal, complete only dtis section and Sections 1, 11, /A. /Y, and /X Ge%x) 430. ❑ 1. NEW PERMIT ® 3. RENEWAL PERMIT ❑ 5. CHANGE OF INFORMATION 6. 'TEMPORARY UST CLOSURE ❑ 7. UST PERAIANENT CLOSURE ON SITE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 4303 1 DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORMATION FACILITY ID q (Agency (IseQnly) - - t BUSINESS NAME (Sane as Fitclllt), Arane or DBA - Doing Business As) 3 Flyers #487 BUSINESS SITE ADDRESS w3. Ci'I'Y 104 983 Moffat Blvd Manteca II. TANK DESCRIPTION TANK ID tE 432. TANK MANUFACTURER 431• TANK CONFIGURATION: THIS TANK IS ;j4• 3 Modern Welding C31.A STAND-ALONE TANK ConVIcte one Me for each ® 2. ONE IN A COMPARTMENTED UNIT con1l"nient in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436• NUMBER OF COMPARTdfENTS IN THF UNIT 437. 1998 4,000 2 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 ❑ S. EMERGENCY GENERATOR FUEL (IISC $25291.5001 439 ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN rj 99. OTHER (SpecilD: CONTENTS PETROLEUA'1: ❑ ta, REGULAR UNLEADED ❑ Ic. MIDGRADE UNLEADED ® lb. PREMIUM UNLEADED 440 ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS 440a ❑ 8. PETROLEUM BLEND FUFL ❑ 9.OTHER PETROLEUM (Specify): �t F` _ - NON•PETROLEUM: 7. USED OIL D 10. ETHANOL14 401 ❑ 11. OTHER NON -PETROLEUMS ci : IV. TANK CONSTRUCTION MWARN NVF TYPE OF TANK ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 95. UNI NOWN 443. 6. INTERNAL BLADDER , 444. PRIMARY CONTAINMENT ®I. STEEL. ❑ 3. FIBERGLASS ❑ � 4 a ❑ 7. STEEL+ INTERNAL LINING ❑ 95. UNKNOWN ❑ 99.OTHER (Spectf3 ): SECONDARY CONTAINMENT ❑ I. STEEL ® 3. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LNEI 7rdACKFTEQ a45. I d� " ; ❑ 90. NONE ❑ 9$. UNYCNOWN © 99. OTHER (Specify): 02 NTA . OVERFILL PREVENTION ❑ 1. AUDIBLE & VISUAL ALARMS ❑ 2. BALL FLOAT ® 3. FILL TUBE SHUT-OFF VAI�VI :� 452:` u g ' 1. TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIP\!EN 1 v.... V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 99. OTHER _. 460 458. SYSTEM TYPE ® 1. PRESSURE Q 2. GRAVITY[13. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION (23 CCR ¢2636(2)(3)] _ PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS _ ❑ S. FLEXIBLE ❑ 10. RIGID PLASTIC 464. 464a ❑ 90. NOME ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): SFCONDARI' CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 8. FLEXIBLE D 10. RIGID PLASTIC 464b (390. NONE ❑ 95. UNKNOWN ❑ 99.OTHER (S i ): 464c. PIPIiZ/fURBINE CDNTANMENT SUMP TYPE ® L SINGLE WAIL [32. DOUBLE A ALL ❑ 90. NONE 464d VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION 464. VENT PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 4640. VENT SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE ❑ 99.OTHER (Specify): 46 fl. VR PRIMARY CONTANMEN'f ❑ L STEEL 0. N 4, FIBERGLASS ❑ 1RIGID PLASTIC [) 90. NONE, ❑ 99.OTIiF.R (Specify): X404 VR SECONDARY CONTAINMENT [31. STEEL ❑ 4. FIBERGLASS [I10. RIGID PLASTIC ®90, NONE. D 99. OTHER (Specify): 464h), 464i. VENT' PIPING TRANSITION S(Iir4P'TYPF. ❑ I. SINGLE WALL Q 2. DOUBLE WALL ®90. NONE ..._ _..... _ ---- 464)'.... RISER PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHF.R (Specify): 464k. RISER SECONDARY CONTAINMENT ❑ 1. STEEL. ❑ 4. FIBERGLASS ❑ I0. RIGID PLASTEC ® 90. NONE ❑ 99.OTIIER (Specify): 464kI._ PILL COMPONENTS INSTALLED ® 1. SPILL BUCKET ® 3. STRIKER PLATEIBOTTOM PROTECTOR ❑ 4. CONTAINAIENT SUi1P 351a•c VII. UNDER DISPENSER CONTAINMENT (UDC) ONE„_- a699_ - CONSTRUC'T'ION TYPE ®1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS _ ❑ 40. NONE ----- CONSTRUCTION MATERIAL ❑ 1. STEEL [14. FIBERGLASS ❑ 10. RIGID PLASTIC ® 99. OTHER (Specify) POIy 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODES ❑ 4. IMPRESSED CURRENT ❑ 6. ISOLATION 448. IX. APPLICANT SIGNATURE CIFRTIFtCr1TION: I certify that this UST system is compatible rvitit tine hazardous substance stores{ and that the Information provided Iterein is true, accurate."d be fall com Mance r le al requirements. 470 APPLICANT SIGNATUR • DATE 10/4/2011 APPLICANT NAME (print) 471. Amanda Agpelt APPLICANT TITLE Environmental Manager 472. g UPCF UST -B Rcv. (12/2007) - 1/2 rrtr wainidomerg