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IFIED PROGRAM CONSOLIDATED F hj IKB 1 / UNDERGROUNDSTORAGETANK S OPERATING PERMIT APPLICATION-TANK INFORMATION(one form r U ) q3o TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this sO 15.CHANGE OF INFIORMATION below) ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL 430b aloe DATE EXISTING UST DISCOVERED: DATE UST PERMANENTLY CLOSED: I. FACILITY INFORMATION - FACILITY ID#(Agency Use Only) 3 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) S irit Gasoline 103 CITY 104 BUSINESS SITE ADDRESS Stockton 1250 North Wilson Way II.TANK DESCRIPTION 434 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS TANK ID# 2 Mid de Modern Welding ®1.A STAND-ALONE TANK ❑2.ONE INA COMPARTMENTED UNIT. ( Cam ide one a for each com meat itithe unit. 437 DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 1 UMBER OF COMPARTMENTS IN THE UNIT 4/1/1995 12,000 Ill.TANK USE AND CONTENTS 439 TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING [I Ic.AVIATION FUELING [13.CHEMICAL PRODUCT STORAGE [14.HAZARDOUS WASTE(Includes Ua d Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC§252d1.5(c)] 439a ❑ 6.OTHER GENERATOR FUEL 1-195.UNKNOWN ❑ 99.OTHER (Specify): 44o CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ I a MIDGRADEUNLEADED lb.PREMIUM GUNLEADED ❑ 3.DIESEL ❑ 5.JET FUEL AS 440a ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM Spec. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL 4401, ❑ 11.OTHER NON-PETROLEUMS ecify IV. TANK CONSTRUCTION 443 TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN qqa PRIMARY CONTAINIv1ENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444a ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 445 SECONDARY CONTAIN1vIENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445e ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): OFF VALVE 452. OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHUT- ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTION ❑1.SINGLE-WALLED I1i12.DOUBLE-WALLED ❑99.OTHER 458 SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 105 DlAIONC[23 CCR§2636(eX3)] 46t PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 464a ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 4641, SECONDARY CONTAINMENT 1.STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. [1 90.NONE [195.UNKNOWN [199.OTHER(Speedy): 464d PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 90.NONE VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464e VENT PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGm PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464¢1 464f VENT SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4640 4641 VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) a46 l 464h VR SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLAS$ ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4Mh1 4641. VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL [190.NONE aha] RISER PRIMARY CONTAINIvIliNT ❑ 1.STEEL ® 4.FIBERGLASS Li 10.M.PLAS 1 ❑ 90.NONE ❑ (Speedy) 4Mil 99.OTHER 464k RISER SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 4 kl FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c VII.UNDER DISPENSER CONTAINMENT(UDC) 469a CONSTRUCTION TYPE ® I.SINGLE WALL ❑ 2.DOUBLE WALL [13.NO DISPENSERS [190.NONE 4696, CONSTRUCTION MATERIAL ❑ 1.STEEL N 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) VIII. CORROSION PROTECTION "8 STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION IK APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full com liance with 1 al requirements. 470. APPLICANT SIGNATURE DATE Z Z _ p� 4n. alt. APPLICANT TITLE Operator/Owner APPLICANT NAME(print) JOgindei Lal Rev.(12/2007) UPCF UST-B-1/2