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AM, Allik 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: 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# T- Q 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. T-3 Diesel D W 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, 10,000 2 III.`TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ 1c.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(includes Used Oil) ❑ 5.FR PI Y G6T RA$OR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOW N ❑ 99 fy)_t 439a. ............... .._...................._. .............................._........ ............... *r�sm- - ................. ................. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lbLE D A 0. ® 3.DIESEL ❑ 5.JET FUEL ❑ 6. IO A `w'mo i + }I3 s k"', x ❑ 8 PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 44oa. .............. ....... ......... .................................. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL �r Qb �y ❑ 11.OTHER NON-PETROLEUM(Specify): { " IV. TANK CONSTRUCTION SAN z�OUI\j TYPE OF TANK ❑ 1 SINGLE WALL ® 2 DOUBLE WALL ❑ 95 UNKNOWN ................... . ...................... ........ ......... .. ........ ...... .............. .y..-r, I 443 PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER a4a. F:FiLlh L L"ra,`, iisflNT 444a. ❑.__7.._STEEL..+_INTERNAL LINING....................._............. .. 95.UNKNOWN ❑ 99.OTHER(Spem....._�i. 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 .46o. ...................................................................................................................... ................. .. ..... I........... ....... ................. .............................................................................................................................................................................................................. ...... ... 458 SYSTEM TYPE ® L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION .0__4r_SAFE SUCTION[23 CCR§2636(a)(3)] .......... ........._............... PRIMARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 44a. _......_.__................................_._._............................................................................................................................................................................................................................................................._.................................................. ............................I.......................... SECONDARY CONTAINMENT ❑ L STEEL ® 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 464d. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): qac 1. ......................................._................-._......................._......._............................................................................................................................................................................................................._............................................................................................................................................................................................. _._..._.. 4bf. VENT SECONDARY CONTAINMENT [11.STEEL El 4.FIBERGLASS El 10.RIGID PLASTIC ® 90.NONE [199.OTHER(Specify): 4fl ......... ................................................................................................................................................................................................................................................................................................-.............................................................._................................................................................................................................ 4............... VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 46 6g, ....................................................................................................................................................................................................................................................................................................................... .. .. ................. ..................................................... VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464h. _.........._.................._..._..._................................................._....................................................................................................................................._................._......_................................_..................................................................................................................................................-.................................................. ......._.....,...... VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 4�` ........................................_...._............................................................................................................................................................._........-.............................._..._......464j. ... RISER PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90 NONE ❑ 99 OTHER(Specify): 464 1. ................................................................_..._..............................................................................................._....._............................................................................ RISER SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE ® 99.OTHER S 10 mil tape abael. [1 [1 [1 [1 ( P(Specify): eci) FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ® 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISPENSER CONTAINMENT (UDC) � :,4- CONSTRUCTION TYPE ® 1 SINGLE WALL ❑ 2.DOUBLE WALL [_3 NO DISPENSERS Q 90 NON 469a .. ....... ..... _ ......._.. .. ... ... ................................. CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) ' " 469c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION :; ;; aaa. IX, APPLICANT SIGNATUREy CERTIFICATION:I certify that this UST systemi ompatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full com h nce' tth 1 re uir ent APPLICANT SIGNATURE ATE azo. APPLICANT NAME(print) Kevin Hur 471. APPLICANT TITLE Owner ; ,. 472 UPCF UST-B Rev.(12/2007)-1/2 www.unidoes.org