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1 r6i( � 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,completeonly this section and Sections I,II,I1I,IV,and IX below) 430 ❑ I.NEW F"O/tM t ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 430b I. FACII.ITY:INFORMATIbN FACILITY ID M(Agency Use Only) F A Q - (j 5 9 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 UIK STOP MARKET#39 BUSINESS SITE ADDRESS 103 CITY 104 2285 EAST FREMONT STREET STOCKTON II,'TANK I)ESCRIPWON, TANK IDM 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS a3a #1(RUL 87 OCTANE) XERXES .A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Complete one page for each com m ment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALS 436 NUMBER OF COMPARTMENTS IN THE UNIT a37 LON NOVEMBER 21,1998 12,000 1 III.TANtC.USE ANI)CONTENTS TANK USE 1a.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(.)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: FI a.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED 0[L ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): aaob IY. TANKCUNSTRUCTYON TYPE OF TANK ❑ 1.SINGLE WALL el DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ L STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING Cl 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ L STEEL V3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify) 445a OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPI G CONSTRUCTION PIPING CONSTRUCTION ❑X.SINGLE-WALLED 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(ax3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL gr4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGITURBINE CONTAINMENT SUMP TYPE Wr 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT;V°APOR;RECOVE/R►Y(VR)A1VU'�iISER'/FILL PIPE PIPING CONSTRUCTION " VENT PRIMARY CONTAINMENT ❑ L STEEL K 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE 0 99,OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS C1 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 46417 464171 VR PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE ❑ 99.OTHER(Specify) 4648 464g I VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99,OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE Cj 1.SINGLE WALL ❑ 2.DOUBLE WALL jr9O.NONE 4641. RISER PRIMARY CONTAINMENT Nl.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464'I RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 01,90.NONE ❑ 99.OTHER(Specify) 464k 464kl FILL COMPONENTS INSTALLED 1.SPILL BUCKET el STRUCER PLATE/BOTTOM PROTECTOR W14.CONTAIIYMENT SUMP 451a-c VII UNDERDISPESER CONTAINMENT(UDC) CONSTRUCTION TYPE 1.SINGLE WAI r � ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL -IBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b-c O1tRO�SI4NP�ItO !CT[ON F STEEL COMPONENT PROTECTION ❑ 2.S ANODE(S) ❑ 4.DAPRESSED CURRENT 6.ISOLATION aas Q►, ..t J. APLICANT STGNATUItEk CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance wit al requirements. APPLICANT SIGNATURE`� DATE August 28, 2009 470 APPLICANT NAME(print) Mike�Karvelot, 471. APPLICANTTITLE Director, Environmental Affa s 432 for Quik Stop Markets,Inc. � C!"«_ :« LJ UPCF UST-B-1/2 Rev.(12/2007)