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Auto <br /> IED PROGRAM CONSOLIDATED FO <br /> UNDERGROUNDSTORAGETANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) <br /> TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,771,IV,and IX below) 430. <br /> ❑ 1.NEW PERMIT E 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 430.. 1 DATE EXISTING UST DISCOVERED: 430b. <br /> L FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) 1. <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> Tower Market# 886 <br /> BUSINESS SITE ADDRESS 103. CITY Iw. <br /> 1434 W. Yosemite Ave. Manteca,CA 95337 <br /> II. TANK DESCRIPTION <br /> TANK ID# ` 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. <br /> AC7 4'� 'C1 ® 1.ASTAND-ALONE TANK Compine one pose for eacb <br /> 886-Reg Modem Welding ❑ 2.ONEINA COMPARTMENTED UNIT cumpanme.im Weork. <br /> DATE UST SYSTEM INSTALLED 436. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. <br /> 1991 12,000 1 <br /> III. TANK USE AND CONTENTS <br /> TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ In.AVIATION FUELING 439. <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ivclodes Uacd Oa) ❑ 5.EMERGENCY GENERATOR FUEL[HSC¢25181.5(c)] <br /> _❑ 6.OTHER GENERATOR FUEL _ ❑ 95.UNKNOWN _ ❑ 99.OTHER(Specify): 439e. <br /> CONTENTS PETROLEUM: N Ia.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440. <br /> ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify)__ 440a <br /> NON-PETROLEUM:(] 7.USED OIL ❑ 10.ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUM(Specify): "On. <br /> TV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 443. <br /> PRIMARY CONTAINMENT N 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. <br /> _❑ 7.STEEL+INTERNAL LINING [1 95.UNKNOWN ❑ 99.OTHER(Specify): 444a <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ®99.OTHER(Specify): Steel Clad W/Fiberglass reinforced plastic 445% <br /> OVERFILL PREVENTION N I.AUDIBLE&VISUAL ALARMS N 2.BALL FLOAT N 3.FILL TUBE SHUT-OFF VALVE 452. <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑ 1.SINGLE WALL_-N 2.DOUBLE WALL C199.OTHER 460. <br /> _ ._.-.._-_ -.___ ._..... . _ . . ...._ .__ <br /> SYSTEM TYPE _ _ ® 1 PRESSURE ❑ 2 GRAVITY _O_3.CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION[2J-CCR__ ¢2636(aJ(3p 458.__ <br /> PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): _464a. <br /> ____-- <br /> SPCONDARY CONTAINMENT ❑ L STEEL N 4.FIBERGLASS ❑ B.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. <br /> _ _ ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): _464e. <br /> PIPING/TURBINE CONTAINMENT SUMP TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. <br /> VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION' <br /> VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS El 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46�4e <br /> VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): <br /> 464flm <br /> VR PRIMARY CONTAINMENT C31.STEEL N 4.FIBERGLASS C110.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46441 <br /> IM . <br /> VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE ❑ 99.OTHER(Specify): 4�hl. <br /> VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL N 90.NONE �4t <br /> RISER PRIMARY CONTAINMENT N 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q46 i <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC N 90.NONE 1199.OTHER(Specify): 4664kk: <br /> FILL COMPONENTS INSTALLED N 1.SPILL BUCKET N 3.STRIKER PLATE/BOTTOM PROTECTOR N 4.CONTAINMENT SUMP 45la-c. <br /> VIL UNDER DISPENSERCONTAINMENT (UDC) <br /> CONSTRUCTION TYPE ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469. <br /> ............ ... ........ _.-....... _._ --....-....___- <br /> CONSTRUCTION MATERIAL N 1.STEEL El 4.FIBERGLASS El 10.RIGID PLASTIC El 99.OTHER(Specify) 4696. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. <br /> IX APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, <br /> accurate and in Wompliance with lego1jrequirements. <br /> APPLICANT SIGNATURE DATE 1/5/201 410 <br /> APPLICANT NAME(print) Paul Chevalier 411. APPLICANT TITLE MaintenanceManager 4'2 <br /> UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org <br />