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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 pen mnent closure or removal,catnplete only this section and Sections I,II,III,IV,and IX below) 430 <br /> ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION <br /> 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE Q 8.UST REMOVAL <br /> DATE UST PERMANENTLY CLOSED: 4306 1 DATE EXISTING UST DISCOVERED: 430b <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) 1 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> QUIK STOP MARKET 0124 <br /> BUSINESS SITE ADDRESS 103 1 CITY tat <br /> 505 NORTH MAIN STREET MANTECA <br /> IL TANK DESCRIPTION <br /> TANK ID 432 TANK MANUFACTURER 473 TAML CONFIGURATION: THISTANK L4 434 <br /> TANK 82(UNLEADSO )(ERXES VT A STAND-ALONE TANK <br /> PLUS,89 OCTANE)-fV'�L)j ❑2.ONE IN A COMPARTMENTED uwr. <br /> DATE UST SYSTEM INSTALLED 433 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 ta.MOTOR VEHICLE FUELING ❑ 1b.MARINA FUELING ❑ le.AVIATION FUELING 439 <br /> ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Lxtuda Uai Oiq ❑ S.EMERGENCY GENERATOR FUEL[HSC 125291.5(c)] <br /> ❑ &OTHER GENERATOR FUEL ❑ 95. WN ❑ 99 OTHER fyr 439& <br /> CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED Irle.MWORADEUNLEADED ❑ ib.PREMIUM UNLEADED 440 <br /> ❑ 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS <br /> ❑ L PETROLBUM BLEND FUEL ❑ 9.OTHER PETROLEUM 4406 <br /> NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL <br /> ❑ 11.OTHER NON-PETROLEUM 440b <br /> IV. TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL2.DOUBLE WALL 0 95.UNKNOWN 443 <br /> PRIMARY CONTAINMENT ❑ 1.STEEL ffirl FIBERGLASS 0 &INTERNAL BLADDER 444 <br /> ❑ 7.STEEL+INTERNAL El 93.UNKNOWN ❑99.OTHER 4446 <br /> SECONDARY CONTAINMENT El 1.STEEL .PMERGLASS El IL EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 <br /> 90.NONE ❑ 9S.UNKNOWN C1 99.OTHER sm 443a <br /> OVERFILL PREVENTION 8 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. <br /> ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT <br /> V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION ❑k.SINGLE-WALLED 2.DOUBLY-WALLED 13 99.OTHER 460 <br /> SYSTEM TYPE ErI.PRESSURE ❑ 2.GRAVITY 3.CONVENTIONAL SUCTION E3 4.SAFE SUCTION Its CCR 12636(spj 459 <br /> PRIMARY CONTAINMENT E3 I.STEEL 1W4.FIBERGLASS S.FLEXIBLE 13 10.RIGID PLASTIC 464 <br /> ❑90 NONE ❑93.UNKNOWN ❑ 99.OTHER( ): 464a <br /> SECONDARY CONTAINMENT El 1.STEEL 1r4.FIBERGLASS &FLEXIBLE 13 10.RIGID PLASTIC 466 <br /> [190.NONE ❑P.UNKNOWN ❑ 99.OTHER(Specify): 464 <br /> PIPINGITURBRNE CONTAINMENT SUMP TYPE OF I.SINGLE WALL 2.DOUBLE WALL 0 90.NONE 4644 <br /> VL VENT,VAPOR RECOVE Y(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION <br /> VENT PRIMARY CONTAINMENT 0 1.STEEL IF4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE 99.OTHER(Speeihr) 464 <br /> 4641 <br /> VENT SECONDARY CONTAINMENT 1.STEEL El 4.FIBERGLASS 0 10.RIGID PLASTIC 01goi.NONE 99.OTHER(Specify) 464f <br /> 464n <br /> VR PRIMARY CONTAINMENT 13 L STEEL MI.FIBERGLASS C3 10.RIGID PLASTIC 0 90.NONE 13 99.OTHER(sw*) 4646 <br /> *ftl <br /> VR SECONDARY CONTAINMENT 1.STEEL 4.FIBERGLASS 13 10.RIGID PLASTICe-NONE 13 99 OTHER(Spcify) 464 <br /> 4661 <br /> VENT PIPING TRANSITION SUMP TYPE 13 1.SINGLE WALL 0 2.DOUBLE WALL 90.NONE 464L <br /> RISER PRIMARY CONTAINMENT ffirl.STEEL U 4.FIBERGLASS 13 10.RIGID PLASTIC 13 90.NONE 13 ".OTHER(SM*) 4" <br /> 7 <br /> RISER SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS 13 10.RIGID PLASTIC 90.NON? CY99.OTHER(Spa*) 466 <br /> 4661 <br /> FILL COMFONDM--INSTALLED 1.SELL BUCKET3.STRIKER PLATF/BOTTObt PROTECTOR 4.CONTAINMENT SUMP 45164 <br /> VII.UNDER DISPENSER CONTAINMENT <br /> CONSTRUCTION TYPE Wk SINGLE WALL ❑ 2.DOUNi WALL ❑ 3.NO DISPENSERS ❑90.NONE 4Na <br /> CONSTRUCTION MATERIAL W 1.STEEL 4.FIBERGLASS Q 10.RIOR/HASH ".OTHER 469be <br /> VIII. CORROSION PROTECTION <br /> STEEL COMPONENT PROTECTION ❑2.SACRIFICIAL ANODE(S) ❑4.DAPRESM CURRENT b.ISOLATION j 449. <br /> IX APPLICANT SIGNATURE <br /> CERTMCATION:I cert[fy that this UST system Is eweWbie with No haaasrdo919 sabehmm sbrod ani th d tha hg9ara rYra PeVWW hotrd>.i9 tsw,saw** <br /> and in full <br /> APPLICANT SIGNATURE,,�r DATE April 8,2010 470' <br /> APPLICANTNAME Mike Karvelot, for 471. APPLICANT TITLE Director of Environmental °' 472• <br /> Qulk Stop Markets, Inc. Affairs <br /> UPCF UST-B-1/2 M- <br />