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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK NOV 15 2016 OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sectionsl�I�1{� i I ® 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE s AD&W9W, ,L HEAD ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DPRARTMENT DATE UST PERMANENTLY CLOSED: N/A 43oa DATE EXISTING UST DISCOVERED: N/A 430b I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 A6:-5 FUEZ rut. _M0510813 fleA r} BUSINESS SITE ADDRESS 103 1 CITYloa 1490 SOUTH MAIN STREET MANTECA J I'ZI114 II.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 1 CONTAINMENT SOLUTIONS ® 1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Com tete one easefor each com artment in one unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 01/15/2017 20,000 1 III.TANK USE AND CONTENTS TANK USE IN la.MOTOR VEHICLE FUELING ❑ If MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ 1 c.MIDGRADE UNLEADED ❑ If.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.01HER PETROLEUM (Specify): 44oa NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ II.OTHER NON-PETROLEUM(Specify): 440b IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ L STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ I.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445a OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT IN 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-WALLED El 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL $1 4.FIBERGLASS Cl 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): a64a SECONDARY CONTAINMENT ❑ 1.STEEL El 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE 4644 VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e cl VENT SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS [:10.1RIGID PLASTIC El 90.NONE ❑ 99.OTHER(Specify) 464F 464n VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ HL RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464, VR SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS C110.RIGH)PLASTIC ❑ 90.NONE [199.OTHER(Specify) 4464h 4644] VENT PIPING TRANSITION SUMP TYPE ❑ L SINGLE WALL 2.DOUBLE WALL ❑ 90.NONE 664,. RISER PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464j 464'1 RISER SECONDARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 70.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641, 4 Ikl FILL COMPONENTS INSTALLED 1.SPILL BUCKET IN 3.STRIKER PLATE/BOTTOM PROTECTOR El 4.CONTAINMENT SUMP 4516-c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL in 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL ❑ L STEEL 29 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696, VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this LIST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal re irements. APPLICANT SIGNATUREDATE 470. APPLICANT NAME(print) (ANNIE ET SA HU 471- APPICANT TITLE 472. f(PEVT UPCF UST-IB-1/2 Rev.(12/2007)