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FIED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (one form per UST) TYPE OF ACTION (Check one item only. For a UST closure 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: 430x. 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. MCI, dba, Verizon Business BUSINESS SITE ADDRESS 103. CITY 104. 2551 E. Louise Avenue Manteca II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 1 Xerxes ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 1985 550 1 III. TANK USE AND CONTENTS TANK USE ❑ la.MOTOR VEHICLE FUELING ❑ ]b.MARINA FUELING ❑ 1c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ® 5.EMERGENCY GENERATOR FUEL[HSC 025281.5(c)] ❑..._6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN......................................................................................................_❑ 99 OTHER(Specify): 439a. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ ]c.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.OTHERNON-PETROLEUM(Specify): 4406. IV. TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ® 2.DOUBLE WALL [I95.UNKNOWN 443. PRIMARY CONTAINMENT ..... .................................. ...................... .... .............................................................. .... ❑ 1.STEEL0 3.FIBERGLASS ❑ 6.INTERNAL BLADDER444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN [199.OTHER(Specify): 444a.... ............ .......... SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90:NONE.............................._❑ 95.UNKNOWN..__.........._...._❑99.OTHER(Specify):... 445a. ............. ....._........................................... OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 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 ❑ I.PRESSURE 0 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. ❑ 9o.:_NONE..............................._❑ 95.UNKNOWN.......__..._..._0..._99.OTHER(Specify):...... 464a. .. .................................................... SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46411 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c. ................................................................................................................_....... ....................................................... PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL [32.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION 464e. VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE [199.OTHER(Specify): 464el. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): a464f ......................................................................................- ...__.....................--.-...._..__... ---..__............................................................_......._.......................__....................................._.._..._.........._..........__................-........................__..._._-...................._.............. .................- 464g. VR PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464 1. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ ]0.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 46411 ......................................................................................................................................................................._._................................_._. 464111. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. .............................................................................................................._..._.._..._.................................................................._......._._.._................._._..........................................................................................................................------.................._.._...................................... RISER PRIMARY CONTAINMENT 1.STEEL 4.FIBER LA 464j. ❑ G SS 10.RIGID PLASTIC 90.NONE 99.OTHER ..._®........................._._.._............................_❑............................................................................_❑..........................................❑ ER(Specify): 464'1. 464k. RISER SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464kl. ................................................................................................................................................................................................................................................................................................................................................................................................................................... ...................._.......... ,.. 451x-c..... FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE [:11.SINGLE WALL ❑ 2.DOUBLE WALL ® 3.NO DISPENSERS ❑ 90.NON .! 469a. ........................_........................................................................................................................................................................................---................._..........................................._.................................................................................................................................................................................................................................................... ............................. CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) ]- = . 469b' c. VIII. CORROSION PROTECTION ! STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided eiw-.js true, accurate and in full m fiance with legal requirements. APPLICANT SIGNATURE DATE 4/22/2011 470 APPLICANT NAME(print) Todd Harris 471. APPLICANT TITLE Regional Environmental Manager 472 r T-1,.Ta n-- 1.111-1 .ice