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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(oleo form per usT) TYPE OF ACTION (Check one item only. For an UST pemwlent closure or removal,complete only this section and Secdans I.II,III,IV,and IX below) 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: +30* DATE EXISTING UST DISCOVERED: 4"b L FACILITY INFORMATION FACILITY ID S(Ag my Use Only) _ 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 QUIK STOP MARKET#124 BUSINESS SITE ADDRESS 103 CITY 104 505 NORTH MAIN STREET MANTECA H.TANK DESCRIM`ION TANK ID 432 TANK MANUFACTURER 433 TAW CONFIGURATION:THIS TANK IS 434 TANK#3(PREMIUM XERXES MI.A STAN[)-AL0NE TANK 91 OCTANE) ❑2.OM IN A COMPARED TMENTUNIT. canyw er PW awae6 iathe um DATE UST SYSTEM INSTALLED 433 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 JANUARY 17,IM 8,000 1 III.TANK USE AND CONTENTS TANK USE irl.MOTOR VEHICLE FUELING ❑ Ih MARINA FUELING ❑ la AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(l dW=Wed Oil) ❑ 5.EMERGENCY GENERATOR FUEL(BaC;7S2a1.3(c)l ❑ &OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER( r 439a CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ to MIDORADE UNLEADED lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify), 440b IV. TANK CONSTRUCT M TYPE OF TANK ❑ 1.SINGLE WALL .DOUBLE WALL ❑ 95.UNTO MSN 443 PRIMARY CONTAINMENT E3 1.STEEL 3.FIBERGLASS 0 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING Q 95.UNKNOWN Q".OTWR 444a SECONDARY CONTAINMENT 13 1.STEEL Orl FIBERGLASS E3 a.W=UDR MUMMANE LINER ❑ 7.JACKETED 445 90.NONE 9S.UNKNOWN 99.OTHRR 443a OVERFILL PREVENTION 1.AUD OLE 8,VISUAL ALARMS U 2.BALL FLOAT !FILL TUBE SHUT-OFF VALVE 452• ❑ 4.TANK MEETS RBQUMEMBNTS FOR waIMPTION FROM OVUM M.L MVENTION EQUIPMENT V. PRODUCT/WASTS PIPING CONSTRUCTION PIPING CONSTRUCTION ❑L SINGLE-WALLED V2.DOUBL&WAILED ❑99.OTHER 460 SYSTEM TYPE IV 1.PRESSURE GRAVITY 0 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION CCR IX39$X3)j 433 PRIMARY CONTAINMENT 1.STEEL 4.FIBRRGLASS 0.FLEXIBLE 10.RIGID PLASTIC 464 ❑90.NONE ❑ UNKNOWN ❑ 99.OTHWSP *): 4644 SECONDARY CONTAINMENT ❑ L STEEL 4 FIBERGLASS S.FLEXIBLE ❑ 10.RIGID PLASTIC 464! ❑90.NONE ❑P.UNKNOWN ❑ ".OTHER(Speaft 464c PIPPAYTURBINE CONTAINMENT SUMP TYPE L SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VL VENT,VAPOR RECOVE Y(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS U 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Spa*) 464e 464e1 VENT SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS E3 10.RIGID PLASTY 90.NONE 13 99.OTHER(Spaeuy) 464 4641 VR PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS E3 10.RIGID PLASTIC 13 90.NONE 13 99.OTHER maw 4644 VR SECONDARY CONTAINMENT I.STEEL 0 4.FIBERGLASS 13 10.RKM PLASTIC 90.NONE 0 99.OTHER(Spaeity) 4 4661 VENT P94NG TRANSITION SUMP TYPE 0 L SINGLE WALL 0 2.DOUBLE WALL 90.NOW 4641 RISER PRIMARY CONTAINMENT Orl.STEEL Ll 4.FIBERGLASS 10.RIGID PLASTIC El 90.NONE LI 99.OTHER(Spat*) 4641 1 RISER SECONDARY CONTAINMENT i.STEEL 13 4.FIBERGLASS 0 10.RIGID PLASTIC NONE E3 99.OTHER(Spwify) 466 4661 FILL COMPONENTS INSTALLED 1.SPILL BUCKET WT STRIKER PLATEMOTTON PROTECTOR WT CONTAINMENT SUMP 431" VII.UNDER DISPENSER CONTAIIMMZNT(UDC) CONSTRUCTION TYPE IWL SINGLE WALL ❑ 2.DOUNA WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 46% CONSTRUCTION MATERIAL Irt.STEEL E3 4.FBIER0LAS3 10.UM PLASTIC 99.07M R(Spot*) 4696-c VIII. CORROSION PRO73MON STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4:M CURRENT Mr6.ISOLATION 441. IX. APPLICANT MGNATURE CE1tTIMATM: I artily that dds UST sydm is anValibb walk Ilea barbas subdMas IMM wd Nd No klbvardba p s kavda is"ia AetMCd% sal In hm eawynam w remasb. APPLICANT SIGNATURE /yJ DATE April 8,2010 �t aY4�t 4M APPLICANT NAME Mike Karvelot, for 471. APPLICANT TITLE [)IrecWr Of En- ronnwatal Quik Stop Markets,Inc. Affairs UPCF UST-B-In Rev.(121""