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o ED PROGRAM CONSOLIDATEDFORIW UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (one farm per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections f,A TIL ry and LP 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 43°6 DATE UST PERMANENTLY CLOSED: 43oa. DATE EXISTING UST DISCOVERED: 1: FACILITY IDN(Agency Use Only) I. FACILITY INFORMATION 3. BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) Tower Market# 886104. BUSINESS SITE ADDRESS 103' CITY 1434 W. Yosemite Ave. Manteca,CA 95337 II. TANK DESCRIPTION -71 43z. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434. TANK IDN - 4 C,h 6 L S 1.A STAND-ALONE TANK Complete me page for each 886-Prem Modem Welding ❑ 2.ONE INA COMPARTMENTED UNIT com 77,iu the avh. 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. DATE UST SYSTEM INSTALLED 1 1991 8,000 III. TANK USE AND CONTENTS TANK USE S la.MOTOR VEHICLE FUELING ❑ ]b.MARINA FUELING ❑ AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE C14.HAZARDOUS WASTE(Ivdudes Used Oa) ❑ 5.S.EMERGENCY GENERATOR FUEL[HSC§25181.5439e _❑ 6.OTHERGENERATOR FUEL _❑ 95.UNKNOWN C:199.OTHER(Sp ecify): _ 440. CONTENTS PETROLEUM: Ella.REGULAR UNLEADED O le.MIDGRADE UNLEADED ® ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 5.LET FUEL ❑ 6.AVIATION GAS 44oa ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify)_ NON-PETROLEUM:El 7.USED OIL ❑ 10.ETHANOL 4406 ❑ 11.OTHER NON-PETROLEUM(S2ccifft IV. TANK CONSTRUCTION 443. TYPE OF TANK ❑ 1.SINGLE WALL ®_2.DOUBLE WALL ❑ 95 UNKNOWN _ _ _._._..__ _------ --------Pa -444 IM . PRARY CONTA_IN_MENT _ S 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4448 _ ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 445 SECONDARY CONTAINMENT O 1.STEEL O 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.LACKEYED 445s ❑ 90.NONE ❑ 95.UNKNOWN S 99.OTHER(Specify): Steel Clad W/Fiberglass reinforced plastic a5l OVERFILL PREVENTION S 1.AUDIBLE&VISUAL ALARMS S Z.BALLFLOAT S 3.FILL TUBE SHUT-OFF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIPMENT V PRODUCT/WASTE PIPING CONSTRUCTION S 460. PIPING CONSTRUCTION _❑ 1_SINGLEWA_LLS 1 DOUBLE WALL _❑_99.OTHER _______ ___._.. ........._____. ..-.-.- .......__.... 458. SYSTEMTYPE _______®_1.PRE8SlJRE O Z_GRAVITY ❑ 3.CONVENTIONAL SUCTION 4.SAFE SUCTION[23ee-8263 - ____ _ �4 PRIMARY CONTAINMENT ❑ 1.STEEL E 4.FIBERGLASS 0 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464a ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): -- 464b. SECONDARY CONTAINMENT ❑ 1.STEEL S 4.FIBERGLASS ❑ 8.FLEXIBLE O 10.RIGID PLASTIC 464c ❑ 90.NONE_ El95_UNKNOWN ❑ 99.OTHER(Specify)- _ ------ 464d PIPING/TURBINE CONTAINMENT SUMP TYPE S 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING'CONSTRUCTION 4648. VENT PRIMARY CONTAINMENT ❑ 1.STEEL S 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 460. VENT SECONDARY CONTAINMENT 0 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC S 90.NONE C3 99.OTHER(Specify): 4��. VR PRIMARY CONTAINMENT C11.STEEL S 4.FIBERGLASS 11 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464-g1. 464h VR SECONDARY CONTAINMENT 0 1.STEEL ❑ 4.FIBERGLASS 1110.RIGID PLASTIC S 90.NONE ❑ 99.OTHER(Specify): 464h1_ ci 466i VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL S 90.NONE RISER PRIMARY CONTAINMENT S 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC C1 90.NONE [3 99.O_.__THER(Specify): 44k -_- RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC S 90.NONE ❑ 99.OTHER(Specify): 4641r�. _-_______-- _ 451a<. FILL COMPONENTS INSTALLED S 1.SPILL BUCKET S 3.STRIKER PLATF/BOTTOM PROTECTOR S 4.CONTAINMENT SUMP VIL UNDER'DISPENSER CONTAINMENT (UDC)' 469a CONSTRUCTION TYPE ❑ 1.SINGLE WALL S 2 DOUBLE WALL ❑ 3.NO DISPENSERS _,�.90 NONE __ _ _ .. ....___. __....._. 4696. CONSTRUCTION MATERIAL S 1.STEEL El4.FIBERGLASS El 10.RIGID PLASTIC C399.OTHER(Specify) 469c. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 446. IX. 'APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stared and that the information provided herein is true, accurate and in f corn liance with 1 al re uirements. 410 APPLICANT SIGNATURE DATE 1/5/201 4n 472. APPLICANT NAME(print) Paul Chevalier APPLICANT TITLE Maintenance Manager UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org