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- o SAN JOAQ1r1N COUNTY ENVIRONMENTAL HEAL DEPARTMENT UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form 11 TYPE OF ACTION (Check one item only. For an UST perrrnnlaat closure or removal,complete only this section and Sections I,11,III,TV,and IX blow) 43 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE Q 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a I DATE EXISTING UST DISCOVERED: 430 I. FACHITY INFORMATION FACILITY ID#(dgeNcy Use ONO) _ - 2 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business Aa) UM STOP MARKET#132 BUSINESS SITE ADDRESS 103 CITY 10 3555 HAMMER LANE STOCKTON II.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TP�GURATION: THIS TANK LS 43 #3 Uni., 91 OCTANE) XERXES riQpra.ASTAND-ALONE TANK .)C/ c✓ [12.ONE IN A COMPARTmmm UNIT. l"am~brc ab compwamtin the OWL DATE UST SYSTEM INSTALLED 433 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 43' JANUARY MI. 81008 11 M.TANK USE AND CONTENTS TANK USE if la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ 1c.AVIATION FUFIE40 43 ❑ 3.cHueCAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ohba Ured 01) ❑ S.EMERGENCY GENERATOR FUEL(HSC psni.Xc)l ❑ 6.OTHBR GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 431 CONTENTS PETROLEUM: ❑ Is.REGULAR UNLEADED ❑ le.MIDGRADE UNLEADED irlb.PREMIUM UNLEADED 44 ❑ 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM 44t NON-PETROLEUM: 7.USED OIL Erio.ETHANOL ❑ 11.OTHER NON-PETROLEUM tK IV. TANK CONSTRUCTION TYPE OP TANK 13 1.SINGLE WALL 2.DOUBLE WALL U 93.UNKNOWN 4' PRIMARY CONTAINMENT 0 1.STEED. 3.FEBERGL.ASS 0 6.IIPTERNAL BLADDER 44 ❑ 7.STEEL,+INTERNAL LINING ❑ 9s.UNKNOWN ❑ 99.oupit ( ecio 444 SECONDARY CONTAINMENT 0 1.STEEL. 3.FIBERGLASS E3 6.EXTERIOR MEMBRANE LINER 7.JACKET» 4' 1390.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specifyy: 441 OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FHL TUBE SHM-OFF VALVE 43 ❑ 4.TANK MEETS REQULRMCRM FOR EXUA ION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PHTKG CONSTRUCTION PIPING CONSTRUCTION 1.SINGLE-WALLED V2.DOUBLE-WALLED 13 99.anni M SYSTEM TYPE Or 1.PRESSURE 0 2.GRAVITY L3 3.CONVENTIONAL STICTION 0 4.SAPS SUCTION CCR P636(d)(3)) 4: PRIMARY CONTADI MENT U 1.STEEL Nr4.FIBERGLASS EFS.FLEXWLB U IR RIGID PLASM 4t ❑ 90.NONE ❑ 95.UN1040WN ❑ 99.OTThER(Specityk 46' SECONDARY CONTAINMENT 0 1.STELE. Er4.FIBERGLASS ET K FL 0 10.RIGID PLASTIC 46' 1390.NONE ❑ X.UNKNOWN ❑ 99.OTHER( r 46' PRDKVrURBDM CONTAINMENT SUMP TYPE 1.ENGIS WALL 2.DOUBLE WALL 0 90.NONE 46 VL V]Uff,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTARGAM4T U 1.STEEL. 4.FIBERGLASS 10.RIGIDPLASTIC 90.NONE El 99.OTHER(Specify) 46 4" VENT SECONDARY CONTAINMENT L3 I.SrwL 13 4.FUMGLASS Ej 10.RIGID PLASTIC r 90.NOW 13 99.OTHER(Spe*) 46 464 VR PRIMARY CONTAINMENT 1.STEEL U14.FIBERGLASS 10.RIGID PLASTIC o 90.NONE t3 99.arm(*..*) 46 mil VR SECONDARY CONTAINMENT 0 i.STEEL 13 4.FIBERGLASS 13 10.RIGID PLASTIC Wk.NONE EI 99.OTHER(Specify) 46 4611 VENT PIPING TRANSITION SUMP TYPE SINGLE WALL 0 2.DOUBLE WALL spogo.NONE 46 RISER PRIMARY CONTAINMENT IWI.STEEL 4.FIBERGLASS U 10.RIGID PLASTIC U 90.NONE 1399.OTIM(Spa*) 4E 464 RIM SECONDARY CONTAINMENT I.STEEL 13 4.FIBERGLASS 13 10.RIGID PLASTIC V 90.NONE UOTHER(Specify) 46 �„• 4641 FILL COMPONIRM INSTALLED VISPIMBUaM 3.STRIKER PLATEMOTTOM PROTECTOR4.CONTAINMENT SUM! IV 451r VII.UNDER DISPENSER CONTAINDUNT(UDC) CONSTRUCTION TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL E3 3.NO DIS E3 90.NONE . 46 CONSTRUCTION MATERIAL. El 1.STEEL Ork FIBERGLASS U 10.RIGID PLASTIC 0 99.OTHER ify) 4691 VDI. CORROSION PROTECTION STIIEL.COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT iK ISOLATION 44 UL APPLICANT SIGNATURE CERTIFICATION:1 certify that this UST system is compatible with the bazwdeas substence shred sad that the iafermatiem provMW herein it lcuenrut sad in fail complianee idth kgd requiremseft APPLICANT SIGNATURE r,,## ✓J DATE JUNE 3,2009 4. APPLICANT NAME(print) Mike Karvelot, 471' APPLICANT TITLE Director, Environmental Affairs 4 for Quik Stop Markets Inc.