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U KA� L o IED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One forth per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,!I,IQ IV,and Mbelow) 430. ❑ I NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE DONE EXISTING USTITE ❑D8.UST REMOVAL 4306. DATE UST PERMANENTLY CLOSED: `I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - 3. BUSINESS NAME(Same as Faci(iry Name or DBA-Doing Business As) Tower Market# 886 104. BUSINESS SITE ADDRESS 103. CITY 1434 W. Yosemite Ave. Manteca,CA 95337 IL TANK DESCRIPTION �� 432. TANK MANUFACTURER al TANK CONFIGURATION:THIS TANK IS 43° TANK ID# l \L(4 `�`5 ® 1.A STAND-ALONE TANK complete one page for each 886-Mid Modern Welding ❑ 2.ONEINA COMPARTMENTED UNIT cowp -tinihemut. 43s. TANK CAPACffY IN GALLONS a36 NUMBER OF COMPARTMENTS IN THE UNIT 437. DATE UST SYSTEM INSTALLED 1 1991 10,000 III. TANK USE AND,CONTENTS TANK USE ® la.MOTOR VEHICLE CTFUELING STORAGE ❑ Ib.MARINA US WAS ❑ lc.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ivdude Used Oa) ❑ S.EMERGENCY GENERATOR FUEL[HSC§2528L5439a __ ❑ 6.OTHER GENERATOR FUEL__❑ 95.UNKNOWN __ ❑ 99.OTHER(Specify): 39 CONTENTS PETROLEUM: ❑ Ia.REGUI.AR UN LEAD ED ® lc MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS 440a __❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify):- NON-PETROLEUM:❑ 7.USED OIL ❑ 10.EnJANOL 4406. ❑ 11.OTHER NON-PETROLEUM(Specify): IV. TANK CONSTRUCTION ' 443. TYPE OF TANK ❑ L SMGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN ----------- --------------- .... OTHER(Specify): --.-..-- �4a 0 .JACKETED ------- PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.B4'f'ERNAL BLADDER ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99. 445. SECONDARY CONTAINMETT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER 7. 445a _�-90_NONE - ❑ 95_UNKNOWN ®99_OTHER(Spec'fy) Steel Clad U13E SHUT-OFF reinforced blastic 452 OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT ® 3.FILLTUBE SHUT-OFF VALVE ❑ 4.TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/'WASTE PIPING CONSTRUCTION raa 460. PIPING CONSTRUCTION ❑ L SINGLE WALL ® 2 DOUBLE WALL__❑ 993OTTIDR _ .._.- ❑ 10.RIGID PLASTIC 464 ___ -------- ___..__ _..- 458. SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVffY _❑ .CONVENTIONAL SUCTION _4_SAFE SUCTION R3 CCR pz636(ax _ _ 464. PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE a. _ _❑ 90.NONE Cl 95.UNKNOWN ❑ 99.OTHER(Specify): ___4646. SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASTIC 464c ❑ 90.NONE ❑ 95_UNKNOWN__ ❑ 99.OTHER(Specify).__ _ ------------------_ __--__ -____-____.___ PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1 SINGLE WALL ❑ 2.DOUBLE WALL El 90.NONE VI: VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464c. VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464e1. VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ® 90.NONE ❑ 99.OTHER(Specify): "4r[. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46g�h, VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4hli VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC C1 90.NONE ❑ 99.OTHER(Specify):------ 464k. Specify): k RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 46411. _____...-__ 451ec. FILL COMPONENTS INSTALLED ® L SPILL BUCKET ® 3.STRIKER PLATFJBOTTOM PROTECTOR 9 4.CONTAINMENT SUMP VIL'UNDER DISPENSER CONTAINMENT(UDC) ' 469a. CONSTRUCTION TYPE ❑ 1 SINGLE WALL ® 2.DOUBLE WALL ❑ 3 NO DISPENSERS _ ❑,90 NONE _ _. ........._ - .- --------- -------- _ ...-.__ 9696. CONSTRUCTION MATERIAL ® 1 STEEL ❑ 4 FlBERGLASS ❑ IO RIGID PLASTIC ❑ 99.OTHER(Speedy) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION El 2.SACRIFICIAL ANDD S ❑ 4.IMPRESSED CURRENT Ll 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 herein is true, accurate and jArfiull com lian w' al re drements. 470 APPLICANT SIGNATURE DATE 1/5/2010 4n. APPLICANT NAME(print) PaUI Chevalier 471. APPLICANT TITLE Maintenance Manager UPCF UST-B Rev.(1212007)-1/2 www.unidoes.org