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IED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a LIST closure or removal, complete only this section and Sections 111, 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: 43M I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) - 1 BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3 Gas Depot BUSINESS SITE ADDRESS 103. CITY 104. 1330 E. Yosemite Ave. Manteca II. TANK DESCRIPTION TANK ID # 432- TANK MANUFACTURER 433• TANK CONFIGURATION: THIS TANK IS 434. T-3 Diesel D W FRP ❑ 1 • A STAND-ALONE TANK Complete are page for each ® 2. ONE IN A COMPARTMENTED UNIT canpattment in the unit. DATE UST SYSTEM INSTALLED 435- TANK CAPACITY IN GALLONS 436- NUMBER OF COMPARTMENTS IN THE UNIT 437. 10,000 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 (adudes L%M Oil) ❑ 5. EMERGENCY GENERATOR FUEL [HSC §25281.5(c)) ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 439x. CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ ic. MIDGRADE UNLEADED ❑ 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 ( ify : 440'• 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 444. ❑ 7. STEEL + INTERNAL LINING ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): tea• _ SECONDARY CONTAINMENT ❑ 1_ STEEL ® 3. FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445• ❑ 90. NONE ❑ 95. UNKNOWN [199. OTHER (Specify): 445a. OVERFILL PREVENTION ❑ 1. AUDIBLE He VISUAL ALARMS ❑ 2. BALL FLOAT N 3. FILL TUBE SHUT-OFF VALVE 452. ❑ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 99. OTHER 460. SYSTEM TYPE ® 1. PRESSURE ❑ 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION [23 CCR §2636(a)(3)] 458• PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 464. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 46aa. SECONDARY CONTAINMENT ❑ I. STEEL ® 4. FIBERGLASS ❑ 8. FLEXIBLE ❑ 10. RIGID PLASTIC 4646. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 464c. PIPINGfrURBINE CONTAINMENT SUMP TYPE ® L SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 4644, VI. VENT, VAPOR RECOVERY (VR) AND RISER/ FILL PIPE PIPING CONSTRUCTION PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGIDPLASTIC 1190. NONE 1399.OTHER (Specify): 464eVENT 4640 _ VENT SECONDARY CONTAINMENT E]L STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE ❑ 99. OTHER (Specify): 464n. VR PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 46648. FIBERGLASS ❑ 10. RIGID PLASTIC N 90. NONE ❑ 99.OTHER (Spify): VR SECONDARY CONTAINMENT ❑ L STEEL ❑ 4. FIBec 4644hl. VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBLE WALL N 90. NONE 464 . RISER PRIMARY CONTAINMENT ® 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 464j. 464.1 RISER SECONDARY CONTAINMENT 13 L STEEL ❑ 4. FIBERGLASS ❑ t0. RIGID PLASTIC ❑ �. NONE ® 99.OTHER (Specify): 10 mil k. 4664kL FILL COMPONENTS INSTALLED ® 1. SPILL BUCKET ❑ 3. STRIKER PLATEIBOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 451a -c. VII. UNDER-DISPENSERCONTAINMENT(UDC)_ CONSTRUCTION TYPE ® 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE 469a. CONSTRUCTION MATERIAL ❑ L STEEL N 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 99. OTHER (Specify) 469c. VIII. CORROSION PROTECTION .............. STEEL COMPONENT PROTECTION ❑ 2_ SACRIFICIAL ANODE(S) [14. IMPRESSED CURRENT ® 6. ISOLATION 448. M APPuCA- NT`SIGNt CERTIFICATION: I certify that this UST system . mpadble with the hazardous substance stored and that the information provided herein is true, accurate, and in full com i) nee' th 1 ui n APPLICANT SIGNATURE ATE 7 470. APPLICANT NAME (print) KeVIn HUT V 471. APPLICANT Trmt Owner 472 T)PCV TICT-R Rev. t12/2(M)71- 1/2 www.unidoes.ora