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ik 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 ❑ 1.NEW PF 3+1 040%M ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 431, DATE EXISTING UST DISCOVERED: 430b . � a .. .__ L FACILITY INFORMATION ", FACILITY ID#(Agency Use Only) If - 0 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 UIK STOP MARKET#39 BUSINESS SITE ADDRESS 103 CITY t04 2285 EAST FREMONT STREET STOCKTON TANK ID# 432 TANK MANUFACTURER 433 TAIg CONFIGURATION: THIS TANK IS 434 #2(PUL 9] OCTANE) XERXES Ell.A STAND-ALONE TANK �(I p [12.ONE M A COMPARTMENTED UNIT. D Complete one page for each com aranent in the umt. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 NOVEMBER 21,1998 12,000 1 III..TANK"UStAND CONTENTS' TANK USE la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ S.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439. CONTENTS PETROLEUM: ElIa.REGULAR UNLEADED E] lo.NEWRADE UNLEADED j1b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS ci : 44ob IS! TANK COj"TRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL WtLNG ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL M13.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'::PRODlIT /WASTT12fPIEI1�IC�;CONSTItUCTYON PIPING CONSTRUCTION ❑ .SINGLE-WALLED W72.DOUBLE-WALLED [199.OTHER 460 SYSTEM TYPE RrLPRFSSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR§2636(.)(3)1 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ l0.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ L STEEL W 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ ?2.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGMMrNE CONTAINMENT SUMP TYPE WI.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d Vl:SENT,VAPOR RECOVAND'RISEik FILL PIPE PIPING CONSTRUCTION_ ; VENT PRIMARY CONTAINMENT ❑ L STEEL 4.FIBERGLASS 10.RIGID PLASTIC CJ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE Cl 99.OTHER(Specify) 464f 464f1 VR PRIMARY CONTAINMENT C1 1.STEEL Ft FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4648 464jil VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC W10916.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ❑ .SINGLE WALL ❑ 2.DOUBLE WALL V190.NONE 4641 RISER PRIMARY CONTAINMENT OrL STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464j 464'1 RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED 1.SPILL BUCKET3.STRIKER PLATE/BOTTOM PROTECTOR4.CONTAINMENT SUMP 451 a-c VII.-UNDER DISPENSER CONTAiI!1VIENT CONSTRUCTION TYPESINGLE WALL, El2.DOUBLE WALL El3.NO DISPENSERS C190.NONE 469a CONSTRUCTION MATERIAL \ STEEL ASS C] 10.RIGID PLASTIC ❑ 99.OTHER(Specify4696-c 714 `co osloN°PRoxcror _ ' STEEL COMPONENT PROTECTION C12.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT Rr6.ISOLATION 448. 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 legal requirements. APPLICANT SIGNATURE �y�J ✓� DATE August 28, 2009 470 'M (print) Mike Karvelot, 47 APPLICANTTITLE Director, EnvironmentalAffairs 472. for Quik Stop Markets, Inc. 41 UPCF UST-11-1/2 RI t (128007)