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AM IED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 111,111,IV,and IX 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 DATE UST PERMANENTLY CLOSED: 430a. I DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Gas Depot BUSINESS SITE ADDRESS 103. CITY 104 1330 E. Yosemite Ave. Manteca II. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. [-] 87 DW FRP ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 20,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.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.OTHE l+ F a 439 ' CONTENTS PETROLEUM: ® Ia.REGULAR UNLEADED ❑ 1c.MIDGRADE UNLEADED ❑ ib.PRE EDS * aaQ ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIAT N E' F ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify) 4goa. ........................................_........................................................................................................................................-............................................................................................................................................................. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4401. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2 DOUBLE WALL ❑ 95 UNKNOWN SAN JOAQUI i9 C uNiY,,,. 443 ..... PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER E[JV i,,,)N 1tN;o tiL 444. El + 95.UNKNOWN 99.OTHER Sect n J 7 EEL INTERNAL LINING ❑ ) H�1_�f�L ;� ��-�' SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a. .......................................................................................................-................................................................................................................................................................................................................................................... .................................................. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT ❑ 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 WALL ® 2.DOUBLE WALL ❑ 99.OTHER ........_....................................................................................................................................................................................................................................................................... .. ............. ..................... ........ ........ ....................._460:..... SYSTEM TYPE..............._ ® 1.PRESSURE ❑ 2.GRAVITY ❑....3....CONVENTIONAL SUCTION [14.SAFE SUCTION[23 CCR§2636(a)(3)]„ 458. PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN El 99.OTHER(Specify): 464x. ....................-..............................................................................................................................._................................................................................................. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4641. ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 464c. ......................................................................................................................................._........................................_........ .................................................... PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d. VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION 464e. VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [390.NONE [199.OTHER(Specify): 464el. ..............................................._._......_....._..................................._............................................................................................................................................................................................ .......... ......... _...................................................................................................................................................................................... VENT SECONDARY CONTAINMENT El 1.STEEL [14.FIBERGLASS El 10.RIGID PLASTIC ® 90.NONE El 99.OTHER(Specify): 44 flf. ........................................................................................................................-...................................................................................... ..................... VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS El 10.RIGID PLASTIC [190.NONE [1 99.OTHER(Specify): 46641, .....................................................................................................................................................................................................................................................................................................................................................................................................-............................ 44 . . 99.OTHER..................___._.-.. _........................................._....................................................................................................................................................................................._....................-...................................................................................................................................................................................................... . ..................... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. .................................._...._....._..........-............_..............._._...................................................................................................................................................................................................................................................._...._............................_.............................................................................................................................................................................. 4 ....... RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46q]j ..............................................................................................................................-.............................................................................................................._............................................................................................... RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):]0 mil tape 4......6ak1 .. . . . . .........................................................................................................................................................................................................................................................................................................................................................................................................................................................._............................................. . ...... FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90 NONE 4694. .........................................................-.............................................._.............................................................................................................................................................................................................................................._.... ....................................... ...... CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) ,a, ,,, 4691: VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this T s em is mpatiblc with the hazardous substance stor and th the information provided is true, accurate,and in In co ents. APPLICANT SIGNATURE DATEtA 11-r // 470. APPLICANT NAME(print) Kevin Ur 471. APPLICANT TIT E O er ( Via'. 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org