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3 IWO1z IFIED PROGRAM CONSOLIDATED F I fl1' L' UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TA KINFORMATION(one form per uST) 430 TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section❑ 5.CHANGE OF INFORMATION Ran i below) ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT g,UST REMOVAL ® 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 430b DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: I. FACILITY INFORMATION FACILITY ID t9(Agency Use Only) - BUSINESS NAME(Same as FACILITY NAME or BA Doing Business As) S irit Gasoline toi CITY toa BUSINESS SITE ADDRESS Stockton North Wilson Way II.TANK DESCRIPTION 434 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS TANK ID q 1 PreIIllUlri Modern Welding ®1.A STAND-ALONE TANK 3 ❑ 2.ONE IN A COMPARTMENTED UNIT. Co tele one pa,. wm for uch et in 0m unit 437 DATE UST SYSTEM INSTAL ED 435 TANK CAPACITY IN GALLONS 436 1 UMBER OF COMPARTMENTS IN THE UNIT 4/1/1995 12,000 III.TANK USE AND CONTENTS 439 TANK USE N la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING [I lc.AVIATION FUELING [13.CHEMICAL PRODUCT STORAGE [14.HAZARDOUS WASTE Hncludo Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[NSC§25281.5(c)] OJ9a [1 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UFILEADED N lb.PREMIUM UNLEADED 440 [1 3.DIESEL [15.JET FUEL [16.AVIATION GAS 440a ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S eci NON-PETROLEUM:❑ 7.USED OIL ❑ W.ETHANOL 4406 ❑ ILOTHERNON-PETROLEUM S eci : IV. TANK CONSTRUCTION 443 TYPE OF TANK ❑ 1.SINGLE WALL N 2.DOUBLE WALL ❑ 95.UNKNOWN 444 PRIMARY CONTAINMENT IN i.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4448 ❑ ].STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 445 SECOFIDARY COMAINIviENT ❑ 1.STEEL N J.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER [17.JACKETED 4g5e [190.NONE [195.UNKNOWN [199.OTHER Specify): 452, OVERFILL PREVENTION N 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTION ❑I.SINGLE-WALLED N 2.DOUBLE-WALLED ❑99.OTHER 458 SYSTEM TYPE N L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a$3)] 464 PRIMARY CONTAINMENT ❑ L STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASIIC 4Ma ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4646 SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464c ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464d PIPING/1TIRBINE CONTAINMENT SUMP TYPE [1 1.SINGLE WALL N 2.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PEPE PIPING CONSTRUCTION 464e VENT PRIMARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE 0 99.OTHER(Specify) 464et 464f VENT SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NOF1E ❑ 99.OTHER(Specify) 4MfI 464g VR PRIMARY CONTAINMENT El1.STEEL N 4.FIBERGLASS ❑- 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464 t 4646 VR SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NOF1E ❑ 99.OTHER(Specify) 46441 4641. VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464) RISER PRIMARY CONTAIN1vIENT L] L STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OT (Specify) 4W 4641 RISER SECONDARY CONTAINMENT ❑ 1.STEEL N 4.FB3ERGLASS ❑ 10.RIGIN PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46411 FILL COMPONENTS INSTALLED N I.SPILL BUCKET N :i STRIKER PLAT&BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451e< VII.UNDER DISPENSER CONTAINMENT([TDC) 46 CONSTRUCTION TYPE N 1.SINGLE WALL ❑ 2.DOUBLE WALL DISPENSERS❑ 3.NO [0190.NONE 9a 469 9a CONSTRUCTION MATERIAL ❑ 1.STEEL N4.FIBERGLASS [I10.RIGID PLASTIC ❑ 99.OTHER(Specify) VIII. CORROSION PROTECTION 448 STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION IX. APPLICANT SIGNATURE 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 I al requirements. 470. APPLICANT SIGNATURE -�I a q,M / CJ DATE 2- - z ,_ / � 471 APPLICANT NAME(print) Joginder Lal APPLICANT TITLE Operator/Owner Rev.(12/2007) UPCF UST-B-1/2