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`/FIED PROGRAM CONSOLIDATED FO" r UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One fotm Pcr us ) 430 TYPE OF ACTION (Check one item only. Fora UST closure or removal,complete only this section and Sections].7I,171,IV,and IX below) � rQ/lo p y . ❑ 1.NEW PERMIT CM ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION Y 0 ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL 430 DATE UST PERMANENTLY CLOSED: DATE EXISTING UST DISCOVERED: 1. FACILITY INFORMATION FACILITY IDN(AgencyUse Only) - - 1 BUSINESS NAME(Same as Facibry Name or DBA-Doing Business As) 3_ Fast and Easy Market BUSINESS SITE ADDRESS 103- CITY 104 244 W. Harding Way Stockton, CA II. TANK DESCRIPTION TANK ID N 432 TANK MANUFACTURER 433- TANK CONFIGURATION:THIS TANK IS 434 ] / unknown ® 1.A STAND-ALONE TANK c.'['e one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT --P--a"'he unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 431- 1998 6,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439_ ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL RISC§25281.5(()] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439x, CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ® 1b.PREMIUM UNLEADED 040 ❑ 3.DIBSEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM.BLEND FUEL ❑ 9_OTHER PETROLEUM(S "Oa. 4aaa. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify). "Ob IV. TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ® 2.DOUBLE WALL ❑_95_.UNKNOWN443. PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ b INTERNAL BLADDER 049 ❑_7_STEEL IIINT_ERNAL LINING _...........0.95_UNKNOWN _-- 4 99.OTHER(Specify): 4.4e. SECONDARY CONTAINMENT ❑ I.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 416. ❑ 90.NONE ® 95.UNKNOWN .❑.99 OTHER(SPecify)_ 445.. _.......... ...._-A ..._"'"'_ ... 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 ❑ t.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER _ _ 460- .__..- ._ ...._..___. ........ ..... ---- .__..._ SYSTEM TYPE ® 1.PRESSURE _�2_GRAVI7Y _ _❑_3 CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION(23 CCA§2636(a)(3)1-_ 458. PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4fi4- ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spmify}.. 464a. SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGIDPLASTIC 4646. [I 90:NONE ®.._95:,UNKNOWN [1 99_OTHER(Specify_)_. 464(. PIPINGaURBINE CONTAINMENT SUMP TYPE 0 I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644. 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):unknown ......___ ........................ ......._ ................ .__"__ ....... VENT SECONDARY CONTAINMENT ❑ I STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unknown 4N44Fl _.......... ....------- ............... _...._...... ........._ ......... ._...._ __ 4696. VR PRIMARY CONTAINMENT ❑ t STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC [I 90.NONE ® 99.OTHER(Specify):Uf1]alOwn 464x1 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unknown 4 hi VENT PIPING TRANSITION SUMP TYPE ❑ 1 SINGLE WALL ❑ 2 DOUBLE WALL ❑ 90.NONE 464` ..........._ ____...... ............ __..............1 .__ _ RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 70 RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unknown 464j1_ 4643 ___-.__ --- . .............. .____ ..-...__._ ___.._- .... RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unlalown 4 kl. -_ .........._ ............. .._-.__ FILL COMPONENTS INSTALLED ❑ 1.SPILL BUCKET ❑ 3 STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 4510-, VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 469a. _.... CONSTRUCTION MATERIAL ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ® 99 OTHER(Specify)UDC is present,but 4fi9b 469b type is unknown. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is comps able with the hazardous substance stored and that the information provided herein is true, accurate,and in full compliance with legal re uirements. APPLICANT SIGNATURE < DATE (�. 1 4m. I ( UPCF UST-B Rev.(12/2007)-113 www.unidocs.org