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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UsT) <br /> TYPE OF ACTION (Check one item only. For an UST penranent closure or removal,co npkte only this section and Sections 411,111,IV,and IX below) 430 <br /> ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION <br /> 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 0 S.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 4305 DATE EXISTING UST DISCOVERED, 4305 <br /> I. FACILITY INFORMATION <br /> FACILITY W#(Agency Use Onty) _ 1 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> QUIK STOP MARKET#124 <br /> BUSINESS SITE ADDRESS 103 CITY 104 <br /> 505 NORTH MAIN STREET MANTECA <br /> II.TANK DESCRIPTION <br /> TANK ID 432 TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434 <br /> TANK#1 (REGULAR UNL, XERXES I11.ASTAND-ALONE TANK <br /> 87 OCTANE) ❑2.ONE IN A COMPARTMENTED UNIT. <br /> comokft am for each emopmunm is the W*. <br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 <br /> JANUARY 17,1985 10,000 1 <br /> III.TANK USE AND CONTENTS <br /> TANK USE irt.MOTOR VEIOCLE FUELING ❑ lb.MARINA FUELING ❑ le.AVIATION FUELING 439 <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(bchW=Umd 0d) ❑ 5.EMERGENCY GENERATOR FUEL[HSC J23281.5(e)] <br /> ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑99.OTHER(Specify): 4399 <br /> CONTENTS PETROLEUM: ffirla.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 <br /> ❑ 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS <br /> [38.PETROLEUM BLEND FUEL [39.OTHER PETROLEUM 4409 <br /> NON-PETROLEUM:❑ 7.USED OIL E3 10.ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUM440b <br /> I.V. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL del.DOUBLE WALL ❑ 95.UNKNOWN 443 <br /> PRIMARY CONTAINMENT ❑ 1.STEEL W3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 <br /> ❑ 7.SPIEL+INTERNALINING 1395.UNKNOWN 13 99.OTHER 4445 <br /> SECONDARY CONTAINMENT 1.STEEL FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER4459 <br /> OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS L3 2.BALL FLOAT SEE3.FILL TUBE SHUT-OFF VALVE 452• <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODU /WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION W4GLE-WALLED W2 DOUBLE-WALLED Q 99.OTIlER 460 <br /> SYSTEM TYPE Wt.PRESSURE GRAVITY 0 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION t23 Celt 12636(ax3) 458 <br /> PRIMARY CONTAINMENT El 1.STEEL W 4.FIBERGLASS 7ff!s.FLEXIBLE 0 10.RIGID PLASTIC 464 <br /> ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTIIEW*K): 4645 <br /> SECONDARY CONTAINMENT 1.STEEL gr4.FIBERGLASS &FLEXIBLE ❑ 10.RIGID PLASTIC 4646 <br /> ❑ 90.NONE ❑4.UNKNOWN (3 ".OTHER(Specify), 4644 <br /> P1PING1TUR3INE CONTAINMENT SUMP TYPE UF 1.SINGLE WALL I 2.DOUBLE WALL ❑ 90.NONE 4644 <br /> VI.VENT,VAPOR RECOVE Y(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT 1.STEEL W4.FIBERGLASS L3 10.RIND PLASTIC 13 90.NONE 0 99.OTHM(Specify) 46441 <br /> VENT SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 0 f9 OTHER(Specify) 46K <br /> 464n <br /> VR PRIMARY CONTAINMENT 13 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 0 9*.OTHER(Specify) 46/s <br /> VR SECONDARY CONTAINMENT C3 1.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC 9 90.NONE 99.MUM(Specify) 460 <br /> 4601 <br /> VENT PIPING TRANSITION SUMP TYPE L SINGLE WALL El 2.DOUBLE WALL W490.NONE 4641 <br /> RISER PRIMARY CONTAINMENT Irl.STEEL El 4.FIBERGLASS 10.RIGID PLASTIC E3 90.NONE 0 ".OTHER(Specify) 464' <br /> RISER SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC r 90.NONE 13 90.OTHER(Specify) 466 <br /> MAI <br /> FILL COMPONENTS INSTALLED 1.SPILL BUCKET3.STRIKER PLATF/BOTTOM PROTECTOR 944.CONTAINMENT SUMP 451&4 <br /> VII.UNDER DL%NSER CONTAINMENT(UDC) <br /> CONSTRUCTION TYPE VA.SINGLE WALL ❑ L DOUNLB WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 4695 <br /> CONSTRUCTION MATERIAL 1.STEEL Ij 4.FIBERGLASS 10.RIGID PLASTIC 99.OTIlER 46 <br /> VIII. CORROSION PROTiCTION 09 <br /> STEEL COMPON M PROTECTION ❑2.SACRIFICIAL ANODE(S) ❑4.DA» CURRENT 1r6,ISOLATION 148. <br /> IR. APPLICANT SIGNATURE <br /> Ctfffiff1CAT11(riV:I cwfNy tot ebb UST srat4e.e Is eaapatlble wNh the bas►iaas sahataaae stand a mel that the Whraatiea pMsi hail'is Is amerate, <br /> aid Y far campftaive wkb bad <br /> APPLICANT SIGNATURE ..J DATE April 8,2010 <br /> 470. <br /> APPLICANT NAME Mike Karvelot, for 471. APPLICANT TOILE Director of Envlronrmnl pf 472' <br /> Quik Stop Markets, Inc. Affairs <br /> UPCF UST---1/2 W 114.n2lsRm <br />