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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST dosure or removal; complete only this section and Sections I, A III, IV, and IX below) 430. ❑ 1. NEW PERMIT ❑ 3. RENEWAL PERMIT ® 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE ❑ 7. UST PERMANENT CLOSURE ON SITE ❑ 8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 430 DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION: FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3 Gas Depot BUSINESS SITE ADDRESS 103. 1330 E. Yosemite Ave. CITY 104. Manteca II. TANK DESCRIPTTON.. TANK ID # 432- T-2 91 TANK MANUFACTURER 433- DW FRPEl1. TANK CONFIGURATION: THIS TANK IS 434. A STAND-ALONE TANK Complete one page for each ® 2. ONE INA COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435- TANK CAPACITY IN GALLONS 436- 10,000 NUMBER OF COMPARTMENTS IN THE UNIT 437. 2 _., III.TATK.USE AND CONTENTS TANK USE ® la. MOTOR VEHICLE FUELING ❑ Ib. MARINA FUELING ❑ 1c. AVIATION FUELING 439. ❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (ir dudes Used Oil) ❑ 5. EMERGENCY GENERATOR FUEL [HSC §=s i.5(e)] ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 439a. CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ Io. MIDGRADE UNLEADED N Ib. PREMIUM UNLEADED 440. ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ❑ 8. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (Specify): 440a. NON PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL ❑ 11. OTHER NON -PETROLEUM (Specify): fib. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL N 2. DOUBLE WALL ❑ 95. UNKNOWN 443. PRIMARY CONTAINMENT ❑ 1. STEEL ® 3. FIBERGLASS ❑ 6. INTERNAL BLADDER 447 ❑ 7. STEEL + INTERNAL LINING ❑ 95_ UNKNOWN ❑ 99. OTHER (Specify): 444a. SECONDARY CONTAINMENT ❑ 1. STEEL ® 3. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 445x. OVERFILL PREVENTION ❑ 1. AUDIBLE & VISUAL ALARMS ® 2. BALL FLOAT [1 3. FILL TUBE SHUT-OFF VALVE 452• ❑ 4. TANK MEETS REQUIREMEMS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT I WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 99. OTHER 460• SYSTEM TYPE ®1. PRESSURE 132. GRAVITY El 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION I'-3 CCR §2636(.)(3)] 458. PRIMARY CONTAINMENT ❑ 1. STEEL ® 4- FIBERGLASS ❑ 8. FLEXIBLE ❑ l0. RIGIDPLASTIC 464. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.OTHER (Spmify): 464s SECONDARY CONTAINMENT ❑ 1. STEEL ® 4- FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464b. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99, OTHER ( fy): 464c. PIPINGlTURBINE CONTAINMENT SUMP TYPE ® 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 4"d. VENT, VAPOR RECOVERS' {YR} AND RISER / FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT El 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 4el VENT SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE ❑ 99. OTHER (Specify): Wn: 64 s. VR PRIMARY CONTAINMENT ❑ 1. STEEL IR 4. FIBERGLASS ❑ 10. RIGID PLASTIC [390. NONE [199.OTHER (Specify): 464. VR SECONDARY CONTAINMENT ❑ 1- STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE ❑ 99. OTHER (Specify): hh. VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBLE WALL N 90. NONE 464'' RISER PRIMARY CONTAINMENT N 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 4i j _. RISER SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE N 99. OTHER (Specify): 10 mil 464kl FILL COMPONENTS INSTALLED N 1. SPILT, BUCKET 0 3. STRIKER PLATEIBOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 45la-a SII. _UNDER DISPENSER CONTAINMENT .IUPC) CONSTRUCTION TYPE ® 1. SINGLE WAIL ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469x. CONSTRUCTION MATERIAL ❑ 1. STEEL ® 4. FIBERGLASS 1:310. RIGID PLASTIC ❑ 99. OTHER (Specify) 69c: VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODES 0 4. IMPRESSED CURRENT ® 6. ISOLATION 44$ - IX. APPLICANT SIPN1�TURE CERTIFICATION: I certify that this UST system is conpatible with the does substance stored and that the information provided herein is true, accurate, and in full compliancevOfg lexalAhinkenteQ APPLICANT SIGNATUREDATE 470. APPLICANT NAME (print) Kevin Hlir ! ` . 471 APPLICANT ft I E er 472. f v rrDt"F rTRT_R 1QPv 11717AB71- 112 / nnitdnt c nm