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UNIFIED PROGRAM CONSOLIDATED FORNI UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION tone fo-1 per usT) TYPE OF ACTION (Check one item only: For a UST closure or removal,complete only this section and Sections 1,11,111,II;and LI belo34) 430 ❑ 1.NEW PF.RNIIT ® 3.RENEWAL.PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 3.UST RPMOVAL DA'Z'E UST PERMANENTLY CLOSED: 4304 1 DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Ilse Onl,) - I BUSINESS NAM E(.Same as%acllity Name or DBA-Doing Business As) 3 Flyers#487 BUSINESS SITE ADDRESS 1D3 CITY l04 983 Moffat Blvd Manteca II. TANK DESCRIPTION TANK 1D# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 3 Modern Welding D I.A STAND-ALONETANK Compfmonepage for each ® 2-ONE IN A COMPARTMENTED UNIT con"mant in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS INTHF 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(imfudcs Used Oil) ❑ S.EMERGENCY GENERATOR FUEL 11ISC§252gi.5(¢)I ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99,OTHER(Specify): 439a COENTS PETROLEUM: ❑ ta.REGULAR UNLEADED ❑ le.MIDGRADE UNLEADED ® lb.PREMIUM UA'LEADED aSO. NT ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL. D 9.Orr[IER PETROLEUbI(Specify): 4404. NON-1'ETROLEIJi`1:❑ 7.USED Oil. ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS i j: 4406. IV. TANK CONSTRUCTION TYPE OF TANK _ ❑ L SINGLE WALL ® 2.DOUBLE WALL. ❑ 95.UNKNOWN 443. PRIMARY CONTAINi,LENT ® I.STEM. ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444• ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNO1NVN ❑ 99,OTHER(Specify): 444a. SECON67m CONTAINMENT ❑ I.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED aa5. _❑ 90.NONE ❑ 95.UNKNOWN D 99.OTHER(Specify): 445a OVERFILI.PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK HEFTS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIP\IENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WAIL ® 2.DOUBLE WALL [199.OTHER _ 4 0 SYSTEM TYPE ® 1.PRESSURE D 2.GRAVITY [13.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR¢2636(4X31) ass. PRIMARY CONTAINMENT ❑ 1.STEEL R 4,FIBERGLASS - ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC -_461 [190.NONE ❑_95.UNKNOWN ❑ 99.OTHER(Specify): a6a�_ SECONDARY CONTAININIENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC d636 [190.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 464c. PIPINGrrumNE CONTAINMENT SUMP TYPE~ ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION a64c. VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4640. 464E VENT SECONDARY CONTAINMENT D 1.STEEL ❑ 4.FIBERGLASS ❑ W.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464n. 464g. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.0THER(Specify): 464 1_ VR SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONF ❑ 99.OTHER(Specify): 4601.4 VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL 19 90.NONE 464i. RISER PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10_RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46811 4641;. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE. D 99.OTHER(Specify): g6tk1. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAIMMENT SUMP 451a-c VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL [1 3.NO DISPENSERS ❑ 90.NONE _ 469a. CONSTRUCTION MATERIAL ❑ t.STEEL E] 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 99.OTHER(Specify)Poly _ 4696 VIII. CORROSION PROTECTION ' ' STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION IX. APPLICANT SIGNATURE C1 RTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided hcrein i arae, accurate rd In full compliance w I legal requirements. '• APPLICANT SIGNATOR s ' DATE 10/4/2011 y APPLICANT NAME(print) Amanda Appelt alt. APPLICANT TITLE Environmental Manager •x 472. UPCF UST-I3 Rev.(1212007)-1/2 wivivainidoes.9rg