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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK r� r0 OPERATING PERMIT APPLICATION-TANK INFORMATION(One N&$e1L§7Tg6 16 TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,ll,III,IV,and IX below) 430 ® L NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST RE NTAL HEALTH DATE UST PERMANENTLY CLOSED: N/A 430s DATE EXISTING UST DISCOVERED: 4301, I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ 1 BUSINESS NAME(Same m FACILITY NAME or DBA-Doing Business As) 3 ikG FuEc ( ,-. TA 66;Z09115 "*r I BUSINESS SITE ADDRESS lm CITY ''22 1490 SOUTH MAIN STREET MANTECA N� 4 H.TANK DESCRIPTION TANKID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THISTANKIS !' 2B CONTAINMENT SOLUTIONS ❑ LA STAND-ALONE TANK ®2.ONE IN A COMPARTMENTED UNIT. complete one pagefor each eom ascent in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 01/15/2017 12,000 2 III.TANK USE AND CONTENTS TANK USE ® Ia.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252a15(n)I ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439. CONTENTS PETROLEUM: ❑ Ia.REGULAR UNLEADED ❑ la MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S eci 440% NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Speeny). 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ I.STEEL KI 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444n SECONDARY CONTAINMENT ❑ I.STEEL 913.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445. 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 ❑ I.SINGLE-WALLED 912.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE El 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(aD)I 458 PRIMARY CONTAINMENT ❑ L STEEL ® 4.FB3ERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Speeify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99,OTHER(Specify) 464f 4640 VR PRIMARY CONTAINMENT ❑ 1.STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99,OTHER(Specify) 4646 464 I VR SECONDARY CONTAINIVIENT ❑ I.STEEL KI 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46,111 464111 VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL IN 2.DOUBLE WALL ❑ 90.NONE 4641. RISER PRIMARY CONTAINMENT ❑ L STEEL M 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 4611 RISER SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED I SPILL BUCKET ® 3.STRIKER PLATEIROTTOM PROTECTOR N 4.CONTAINMENT SUMP 45le-c VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ I SINGLE WALL N 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469% 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 U1jT system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compiale wittRegal re uir ments. APPLICANT SIGNATURE DATE 470 l((r5N APPLICANT NAME(print) (ANNIE)GU ET ANDAU 471. APPLICANT TITLE 472 pRfFfD� UPCF UST-B-I/2 Rev.(12/2007)