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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 1,11,III,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: 430x. I DATE EXISTING UST DISCOVERED: 4306. 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. 1 CITY 104. 1330 E. Yosemite Ave. Manteca II. TANK DESCRIPTION TANK ID#'r Q ' 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. ❑ 1.A STAND-ALONE TANK Complete one page for each T-2 91 DW FRP ® 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. 10,000 2 III. TANK USE AND CONTENTS TANK USE ® Ia.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.OTHER(Specify)_ 439a. ................................-.........................................._....................................._...................................................................................................................................................................................................................................... .. .................._. .. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ® ib.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. ............................................................................................................................_.................-.............__............................................................................................................................................................................................................... NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. IV. TANK CONSTRUCTION TYPE OF TANK 1.SINGLE WALL ® 2 DOUBLE WALL ❑ 95 UNKNOWN 443. ... .. ..... .. .. ................... PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. 0_7.:_STEEL+INTERNAL LINING ❑ 95.UNKNOWN............._0... (Specify).. 444a. .............. . . .......... SECONDARY CONTAINMENT ❑ L 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 . .... ......... ass SYSTEM TYPE ® 1.PRESSURE......................................... ❑ 3.CONVENTIONAL SUCTION 0 4.SAFE SUCTION[23 CCR§2636(x)(3)1 .......................... ........................... PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE [195.UNKNOWN [199.OTHER(Specify): 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 ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644. VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464e. VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS [110.RIGID PLASTIC [10.NONE ❑ 99.OTHER(Specify): 46 94el. .............-.............................................._........................-................................................................_.............................................._..._....._............................................................................................................................................................................................................................................._..._................................. VENT SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS [I10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 46gfl. ... ................................................................................................................................................................._.........................._........................................................................................................................................................................................................................._...................................._................... 4648. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE ❑ 99 OTHER(Specify): gfg81. .................................................__....................._....._.............._........................................-.................................................................................................................................................................................................................................................................. VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 464ht. .....................................-.................................................................................................................................................._........................................-.........................................................................................................................................._...............................-........................................_._......................................... .................. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4641. ._.......................................__.........................._..._........................................................................................................................................._.............................................._...............................................................................................-................................................................................................................._...._._......................................................... .... RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS. [110.RIGID PLASTIC ❑ 90.NONE [199.OTHER(Specify) 46q�j 4�_ .........................................._..................._................_.........__...................._.........._............._.............................................._................................................................................................................................................................................................................... ............. RISER SECONDARY CONTAINMENT ❑ 1.STEEL [14.FIBERGLASS ❑ 10.RIGID PLASTIC [190.NONE ® 99.OTHER(Specify):10 mil tape a6ak.l ............................................_.................................._........................................._...........................................................---................................._..............................................................................................................................................................................._............................... _.._............._......__........_..__..._ FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® L SINGLE WALL ❑ 2 DOUBLE WALL ❑ 3.NO DISPENSERS 90 NONF 4694 ......... ..... .......... ...... ....................................... ...... ......... ................ CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c VIII. CORROSION PROTECTION - t w STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is cifnpatible with the haz dons substance stored and that the information provided herein is true, accurate,and in full compliance wito I al ui e t APPLICANT SIGNATURE DATE ( s APPLICANT NAME(print) Kevin Hur / 471. APPLICANT JITLE6wner 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidoes.org