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UNIFIED PROGRAM CONSOLIDATE FORINT UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form Per UST) TYPE OF ACTION (Check one ilern only. For a UST closure or removal,coutplele only this seclion and Sections I,77.III,IV,,and LY heloa) 43Q ❑ 1.NEW PERMIT ® 3.RENEWAL PFR-,%41'f ❑ 5.CHANGE OF INFORMA'T'ION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENTCLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4304 I DATE EXISTING UST DISCOVERED: 4306, 1. FACILITY INFORMATION FACILITY ID#(Ageucj,Use Dul)) BUSINESS NAME(.Same as Facility Name or DBA-Doing Business As) Flyers#187 BUSINESS SITE ADDRESS 101• CITY t04. 983 lvloffat Blvd Manteca II. TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433. 'TANK CONFIGURA'T'ION:THIS TANK IS 434. El I.A STAND-ALONE TANK Coni icte one papa for each 1 Modern Welding C7 2.ONE INA COMPARTMENTED UNIT con>partmentintile unrt. DATE UST SYSTEM INSTALLED 435, TANK CAPACITY IN GALLONS 436. NUMBER OF COI\[PARTIt4FNTS IN THE UNIT 437• 1998 12,000 1 111, TANK USE AND CONTENTS TANK USE M la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.Eh1FRGENCY GENERATOR FUEL[I{SC�2528t.5(a39� ❑ 6.OTHF.R GENERATOR FUEL 95.UNKNOWN ❑ 99,OTHER(Specify): CONTENTS PETROLEUM:- ❑ lo.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440. ® 3.DIESEL ❑ S.JET FUEL ❑ 6.AWAT10N GAS _ ❑ S.PETROLEUM BLEND FUEL ❑ 9.0THER PETROLEUM(Specify): 44as_._ NON-PFTROLF.0\I:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM S eci ): 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 4444'44. PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS (16.INTERNAL BLADDER ❑ 7.STEEL.t INTERNAL LINING ❑ 95.UNKNOWN [199.OTHER(Specify): 444x. SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN El 0.OTHER(Specify): _a45s. OVERFILL PREVENTION ❑ I.AUDIBLE&VISUAL ALARMS ❑ 2.BALI.FLOAT ® 3.FILL TUBE SHUT-OFF VALVE. 452 Q 4.TANK MEETS RE UIRE1lENTS FOR EXEMPTION FROM OVERFILL PREVENTION F UINNIENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALT, ® 2.DOUBLE WALL ❑ 99. MER _ 460. SYS'TFA,I TYPE ® 1.PRESSURE U 2.GRAVITY ❑ 3.CONVENTIONAL_SUCTION ❑ 4.SAFE SUCTION23l CCR t2636(a)(3)) 455. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLF, 1310.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464x. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 46Jb' ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464`- PIPING/TURBiNE CONTAINNIENT SUMP TYPE ® L SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464& VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT [11.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC (390.NONE ❑ 99,OTHER(Specify): 46icl._ VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTIIFR(Specify): 4640. VR PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464& VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4664hl._ _ '. .... 4641' VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALT, ® 90.NONE RISER PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [] 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Spceil�): 46441L- RISER SECONDARY CON'TAINMEN'T ❑ I.STEEL ❑4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.0'fF[ER(Specify): 464 j ._.. 45la-c. FILL COl\'1PONEN'TS 1NS'CALI.FD ® L SPILL BUCKT"f ® 3.STRIKER PLATEIBO'frOtvt PROTECTOR ❑ 4.CONTAINMENT SUMP VII, UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION'TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE: 469a 469_ CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 99.OTHER(Specify)Poly 469,•. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION Y: 449 IX APPLICANT SIGNATURE CFI2TIFICATION: I certify that this UST system Is compatible with the hazardous substance stored and that the information Provided heelA li 11.01 accurat .s d Tn fill]compilallEgLAV411 Ie al requirements. C]s DATE 470 APPLICANT S[GNA'TUI l0/4Il� 47t. 472. APPLICANT NAME(Print) Amanda Appelt APPLICANT TITLE Environmental Manager UPCF UST-11 Rev.(12/2007)-1/2 wtviv.nuldocs.otg l