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y,�t IED PROGRAM CONSOLIDATED FORV111111/ UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One fame per UST) TYPE OF ACTION (Check one item only. Fora UST closare or removal,complete only this section and Sections 1,11,Ill,If;and IX beloav) 3i0 ❑ 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: d3N I DATE EXISTING UST DISCOVERED: 430n L FACILITY INFORMATION FACILITY ID It(Agency Use Only) 1 -10 Q O - 3 7 0 7 ,. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) AI-IMED'S SONS INCORPORATED BUSINESS SITE ADDRESS 103. CITY 10a 1257 WEST YOSEMITE AVENUE MANTECA H. TANK DESCRIPTION TANK ID k 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. OWENS CORNING 0 1.A STAND-ALONE TANK Complete oae page for each ❑ 2.ONE IN A COMPARTMENTED UNIT came --in the wit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPAR_IME_NTS IN THE UNIT 437 7/1991 12,000 1 III. TANK USE AND CONTENTS TANK USE ® I a.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ialu Usrd Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25281 5(r)) _ ____ ❑ 6.OTHER G_ENERAT_OR FUEL ❑ 95.UNKNOWN ❑ 99 OTHER(Specify): 439.. _ _ _. CONTENTS PEIROLEUM: ❑ Ia.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 4a0a. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406_ IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2 DOUBLE WALL ❑ 95.UNKNOWN 443. ' PRIMARY CONTAINMENT ❑ LSTEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444_ ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ® 99.OTHER(Specify):FRP d06a- SECONDARY CONTAINMENT ❑ 1.STEEL [13 FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ®99.OTHER(Specify): FRP 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 ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFEfiUCTION[23 CCR§263Nax3)] 45E. PRIMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95:UNKNOWN ® 99.OTHER(Specify): FRP awe. SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 46°F. ❑ 90.NONE ❑ 95.UNKNOWN ® 99.OTHER(Specify): FRP 461c. _ ........................a -- PIPING/TURBIN_E CONTAINMENT SUMP TYPE ❑ 7.SINGLE WALL ❑ 2.DOABLE WALL ❑ 90.NONE VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 1_ VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify); VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): VR SECONDARY CONTAINMENT ❑ 1 STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46 VENTPIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE �` RISER PRIMARY CONTAINMENT ® 1 STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify)' RISER SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 4&4kj' FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIXER PLATF/BOTTOM PROTECTOR ® 4.CONTAINMEN7 S _ 451a<. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑_2.DOUBLE WALL ❑ 3.NO DISPENSERS 09_0.NO 469°. CONSTRUCTION MATERIAL ❑ L STEEL ❑ 4.FIBERGLASS ® 10.RIGID PLASTIC - ❑ 99.OTHER(Specify). VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRFSSFD CURRENT ❑ 6.ISOLATION a4a. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provid4 herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE DATE .' aro. APPLICANT NAME(print) NADEEM A INMD 471, APPLICANT TITLE MANAGER 4n UPCF UST-B Rev.(12/2007)-Id www.uaidoca.org