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r.I <br /> �FIED PROGRAM CONSOLIDATED FO,..o I <br /> UNDERGROUNDSTORAGETANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) <br /> TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,III,IV,and IX below) <br /> El I.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION <br /> ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 439s. DATE EXISTING UST DISCOVERED: <br /> I. FACILITY INFORMATION U <br /> FACILITY ID#(Agency Use Only) <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> Fast and Easy Market <br /> BUSINESS SITE ADDRESS 103' CITY 1a_ <br /> 244 W. Harding Way Stockton, CA <br /> II. TANK DESCRIPTION <br /> TANK ID# 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434- <br /> 2 unknown ® 1.A STAND-ALONE TANK Compltte one page for each <br /> ❑ 2.ONE IN A COMPARTMENTED UNIT --Panmmt in the'ai' <br /> DATE UST SYSTEM INSTALLED 435_ TANK CAPACITYIN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437_ <br /> 1998 10,000 1 <br /> III. TANK USE AND CONTENTS <br /> TANK USE ® la.MOTOR VEHICLE FUELING ❑ If.MARINA FUELING ❑ Ic.AVIATION FUELING 439. <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE pndudes Used oil) ❑ S.EMERGENCY GENERATOR FUEL[HSC§25281.5(,,1] <br /> [16.OTHER GENERATOR FUEL _ E395.UNKNOWN __ El 99,OTHER(Specify): 439a. <br /> CONTENTS PETROLEUM: ® la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ 16.PREMIUM UNLEADED 440. <br /> ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify.-.-., <br /> NON-PETROLEUM: 7.USED OIL METHANOL <br /> ❑ 11.OTHER NON-PETROLEUM(Specify): 44pb. <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK 0_l.._SINGLE WALL ® 2_DOUBLE.WALL [I 95 UNKNOWN 443. <br /> -.-...-.-.-.- .....-_.. _ ._... . .......... <br /> PRIMARY CONTAINMENT [11.STEEL ® 3.FIBERGLASS [3 6.INTERNAL BLADDER OOa. <br /> ❑ 7.STEEL+INTERNAL LINING [1 95 UNKNOWN Q 99:-OTHER(Speci ): 444i <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 485. <br /> ❑ 90.NONE ® 95.UNKNOWN ❑99.OTHER(Specify)_ 4'15. <br /> OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION E UIPWNT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION 1.SINGLE WALL ® 2 DOUBLE WALL ❑ 99.OTHER 469. <br /> SYSTEM TYPE ® 1._PRESSURE ❑ 2 GRAVITY_._ �3 CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION[23 C_CR 6263N lOH 458. <br /> PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. <br /> ................_[1 90.NONE E3 95_UNKNOWN_ E_99.OTHER(Specify): 4Na. <br /> SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4616. <br /> [190.NONE ® 95.UNKNOWN El99.OTHER(Specify) <br /> G/ <br /> PIPINTURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d <br /> VI. VENT,VAPOR RECOVERY (VR) AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS E310.RIGID PLASTIC [190.NONE ® 99.OTHER(Specify):un]no,, 46 l <br /> VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS [1 10.RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unknown 4464a <br /> VR PRIMARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE N 99.OTHER(Specify):unknown 4wgs <br /> VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unknown 44Mh <br /> VENT PIPING TRANSITION SUMP TYPE [3I SINGLE WALL [12.DOUBLE WALL ❑ 90.NONE <br /> 4641 <br /> .............. -__-__-.- ... .........-._- <br /> RISER PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10,RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify).unknown 46441. <br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ® 99.OTHER(Specify):unknown y664ki <br /> __._ ................ -- ___ ..................---------- <br /> .-...._.-._- <br /> FILL COMPONENTS INSTALLED ❑ 1.SPIEL BUCKET ❑ 3.STRIKER PLATF/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451., <br /> VII. UNDER DISPENSER CONTAINMENT (UDC) <br /> CONSTRUCTION TYPE ❑ I.SINGLE WALL ❑ 2 DOUBLE WALL [13.NO DISPENSERS � 90 NONE 469.. <br /> CONSTRUCTION MATERIAL El STEEL ❑ 4.FIBERGLASS ❑ 10 RIGIDPLASTIC ® 99 OTHER(Specify)UDC is present but 4696. <br /> 4fi9c <br /> type is unknown. <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION aaa. <br /> IX. APPLICANT SIGNATURE <br /> CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, <br /> accurate,and in full compliance with legal re uirements. q <br /> APPLICANT SIGNATURE DATE 4 I ( ' 1 470 <br /> UPCF UST-B Rev.(12/2007)-113 www.unidoes.org <br />