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J 4.1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT UNDERGROUND STORAGE TANK / I� OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) I�l TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,II,III,IV,and IX below) 430 8'1.NEW PERM11F FdRw{ ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ &UST REMOVAL DATE UST PERMANENTLY CLOSED: 4302 DATE EXISTING UST DISCOVERED: 430b I. FACILITY INFORNlAri?rON, FACILITY ID#(Agency Use Only) _ _ 7 LI I I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 UIK STOP MARKET#148 BUSINESS SITE ADDRESS 103 CITY 104 205 WEST LOCKEFORD LODI EL TANK TION TANK ID# 432 TANK MANUFACTURER 433 TALC CONFIGURATION: THIS TANK IS 434 #3(PUL,91 OCTANE) XERXES •A STAND-ALONE TANK - , ® G ❑2.ONE IN A COMPARTMENTED UNIT. /`'f �U S Complete one page for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 JUNE 1,1988 8,000 1 IQ:TANK ISE�AND CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ ib.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§2528I.5(c)] ❑ 6.OTHER GENERATOR FUEL [195.UNKNOWN ❑-2-9,OT-BER $ cify): 4390 CONTENTS PETROLEUM: C3 1a.REGULAR UNLEADED C1la MIDGRADE UNLEADED lb.PREMIUM UNLEAD 440 ❑ 3.DIESEL ❑ 5.JET FUEL VIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): aaob W. TANK GONSiI1RfTCori TYPE OF TANK ❑ 1.SINGLE WALL DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL WING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify)- 445a OVERFILL PREVENTION Ll1.AUDIBLE&VISUAL ALARMS Lj 2.BALL FLOAT Iff 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT a PRODUCT/WASTE P]PIN,QNSTRUCT,ON PIPING CONSTRUCTION ❑1.SINGLE-WALLED I11r2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE Irl.PRESSURE ❑ 2.GRAVITY C13.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR§2636(.)(3)) 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ K.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL jr4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,IVA POR RECOVERY`.(VWAND RISER/FILL PIPE PIPING CONStkUtT ION VENT PRIMARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC L1 90.NONE 0 99.OTHER(Specify) 464. 464.1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464f 464fl VR PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 4646 464 I VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE .SINGLE WALL C32.DOUBLE WALL 90.NONE 4641. RISER PRIMARY CONTAINM ❑ENT 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4641 464'I RISER SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLED F11.SPILL BUCKET 913.STRIKER PLATE/BOTTOM PROTECTOR e4.CONTAINMENT SUMP 45la•c VII. UNDER DISP.ENSFR`CONTAINMEN�'°(UDC) CONSTRUCTION TYPE Uff 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469a CONSTRUCTION MATERIAL jr 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b c VIM .CORROSfON PROTECTION:;_, .x, STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.McRESSED CURRENT Ir6.ISOLATION 448. IIL APPLICANT 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 with lLrgal re uirements. APPLICANT SIGNATURE y DATE September 8, 2009 470 APPLICANT NAME(print) Mike Karvelot, 471. APPLICANTTITLE Director, Environmental Affaim 472. for Quik Stop Markets, Inc. UPCF UST-B-1/2 Rev.(1212007)