COMPLIANCE INFO_2010-2015 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (011e f0r111 per UST) TYPE OF ACTION (Check one iters only. For a US1'closure a• removal, complete only this section and Sections 1, 11,111,11; and LV below) 430 ❑ 1. NI:W PERNMIT N 3. RENE1itAL PERMIT ❑ 3. CHANGE OF INFORMATION ❑ 6.T FINA PORARY UST CLOSURE ❑ 7. UST PERTNIANENT CLOSURE ON SITE ❑ S. UST REMOVAL DA'Z'E UST PERMANENTLY CLOSED: 4303 1 DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY [D # (Agenc), Ilse Qnly) - t BUSINESS NAM E (.Sane as % acilfty Alame or DRA - Doing Business As) 3 Flyers #487 BUSINESS SITE ADDRESS 103- Cf"E'Y l04 983 Moffat Blvd I Manteca II. TANK DESCRIPTION TANK ID # 432• TANK MANUFACTURER 433• TANK CONFIGURATION: THIS TANK IS 434. 3 ModWelding Modern e g [11. A STAND-ALONE TANK Coapleteone page forcRh N 2. ONE. IN A COMPARTMENTED UNIT colnimAt tent in the unit. DATE UST SYS"I' m INSTALLED 435. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS IN THE UNIT 437 1998 4,000 2 III. TANK USE AND CONTENTS •PANIC USE (D In, MOTOR VEHICLE. FUELING ❑ Ib. MARINA FUELING ❑ le. AVIATION FUELING 439' ❑ 3. CHEMICAL PRODUC f STORAGE ❑ 4. HAZARDOUS WASTE (includes Used Oil) ❑ S. EMERGENCY GENERATOR FUEL (11SC 425291.5(c)) 6.OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99.OTHER (Specifj ): 4391 _❑ Eb_CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ lc. MIDGRADF UNLEADL'D N ib. PREMIUM UAILEADED aao ❑3. DIESEL. ❑ 5. iET FUEL ❑ 6. AVIATION GAS C13. PETROLEUM BLEND FUEL Q 9.OTHER PETROLEUM (Specify)• 440a. - NON-PETROLEUM: ❑ 7. USED OIL ❑ 10. ETHANOL ❑ 11. OTHER NON-PETROLEUM (S cify): 4406. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ® 2. DOUBLE WALL ❑ 95. UNKNOWN 443 PRIMARY CONTAINMENT N 1. STEFI. ❑ 3. Ff8ERGLASS ❑ 6. INTERNAL BLADDER 444. ❑ 7. STEF:L+INTERNAL LINING Q 95. UNKNOIAIIN ❑ 99. OTHER (Specify): 444a. SECONDARY CONTAINMENT [11. STEEL N 3. FIBERGLASS Q 6. EXTERIOR MEMBRANE LINER El7. JACKETED a;s' Q 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 4484 - OVERFILL PREVENTION -❑ 1. AUDIBLE R VISUAL ALARMS ❑ 2. BALL FLOAT ® 3. FILL TUBE SHUT-OFF VALVE 452. ❑ 4, TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION FQUIPMENL' V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION O ]..SINGLE WALL N 2. DOUBLE WALL ❑ 99. OTHER � SYSTEM TYPE ® 1. PRESSURE ❑ 2. GRAVITY ❑ 3. CONVENTIONAL SUCTION ❑ 4. SAFE SUCTION (23 CCR ¢2636(a)f3)) _ PRIMARY CONTAINMENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ S. FLEXIBLE ❑ 10. RIGID PLASTIC 464. El 90. NONE f395. UNKNOWN ❑ 99. OTHER (Specify) 4644 - - SECONDARY CONTAINlklEN'T ❑ 1. STI:rL ® 4. FIBERGLASS ❑ 3. FLEXIBLE Q 10. RIGID PLASTIC 4646. ❑ 90. NONE ❑ 95, UNKNOWN ❑ 99. OTHER (Specify): 464c. _ _. 464dPIPING/TURBINE CONTACVMENT SUMP TYPE ® 1. SINGLE WALL [12. DOUBLE WALL ❑ 90. NONE VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION V£N'T PRIMARY CON'T'AINMENT ❑ I. STEEL N 4. FIBERGLASS El 10. RIGID PLASTIC El 90. NONE El99.OTHER (Specify): 4&403. 464E VENT SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ® 90. NONE ❑ 99.OTHER {Specify): 4640, VR PRIMARY CONTAINMENT ❑ 1. STEEL ®4, FIBERGLASS ❑ 10. RIGID PLASTIC [140. NONE ❑ 99.01'HER (Specify): 464gj _.... _ _ _ 46W. VR SECONDARY CONTAINMENT ❑ 1. STEEP, ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ®40, NONE ❑ 99.OTf{F.R{Specify): 46x61. VENT PIPING TRANSITION SUMP TYPF ❑ 1. SINGLE WALL [12. DOUBLE WALL N 90. NONE 4641. _...... - _._. -.. RISER PRIMARY CONTAINNIENT ❑ 1. STEEL ® 4. FIBERGLASS ❑ 10. RIGID PLASTIC [390. NONE ❑ 99. OTHER (Specify): 46sj1. ---_......-_ _........-___ .._..-_. _-.....-- -- ----- 464A. RISER.SECONDARY CONTAINMENT O 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC N 90. NONE ❑ 99. OTHER (Specify): 464i:1.- FILL COMPONENTS INSTALLED ® I. SPILL BUCKET N 3. STRIKER PLATF/BOTTOM PROTECTOR ❑ 4. CONTAIN\fENT SU,\IP 45la•c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® I. SiNGL_E WALL _ ❑ 2. DOUBLE WALL ❑ 3. NO DISPENSERS ❑ 90. NONE__ 469a 469b. CONSTRUCTION MATERIAL Q 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC N 99. OTHER (Specify) Poly 469c. VIII. CORROSION PROTECTION STEEL COM PONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT ❑ 6. 1SOLATION 448, IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is coulpatible with (lie hazardous substance store(I anti that the Information provitled Iterchi is trete, accurate, xi in frill compliance wjfb legal re(ulremeats. 470 APPLICANT SIGNATURE , " DATE 10/4/2011 471. APPLICANT NAME (Print) Amanda Appelt APPLICANT TITLE r 472. Environmental Manager UPCF US"f-B Rev. (12/2007) -112 www.unidocs.org