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SAN JOAQT&COUNTYENVIRON ORTAL ALE TANK EPARTMENT � �*6'1 UNDERGROUNDOPERATING PERMIT APPLICATION-TANK INFORMATION(one form per uST) �/ TYPE OF ACTION (Check one item only. For an UST ponment closure or renmmL complete only this section and Sections I,11,III,IV,and DL below) ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATIO 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE 0 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a 1 DATE EXISTING UST DISCOVERED: t430 L FACILITY EWORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Sana as FACILITY NAME or DBA-Doing Business As) UIK STOP MARKET#132 BUSINESS SITE ADDRESS 103 CITY 10 3555 HAMMER LANE STOCKTON II.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 ip CONymuRATim TEAS TANK IS #2(Uni.Plus, N OCTANE) XERXES A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. one pqp for eeel canywwwo in*A mit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 431 JANUARY 1991 10,000 1 III.TANK USE AND CONTENTS TANK USE if 1.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ le.AVIATION FUELING 43 ❑ 3.CHEHIICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE pndudw used op) ❑ 5.EMERGENCY GENERATOR FUEL[HSC 121231.1(c)) ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER( y 439 CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 44 ❑ 3.DIl33EL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ s.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM 440 NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM 440 IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2.DOUBLE WALL 0 95.UNKNOWN 44 PRIMARY CONTAINMENT 0 1.STEEL Nrl FIBERGLASS 13 6.INTERNAL BLADDER 44 ❑ 7.MUM+INTERNAL LB41M ❑ 9S.uNKNOWN 0 99.OTHER 444. SECONDARY CONTAINMENT 13 1.STEEL. OM.FIBERGLASS 0 6.EXTERIOR MEMBRANE LINER 7.JACKETED 44 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTIIBR441: OVERFILL PREVENTION E3 I.AUDIBLE a VISUAL ALARM3 0 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 43. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGIZ WALLED IM DOUBLE.-WALLED Q 99.OTHER 46 SYSTEM TYPE lE 1.PRESSURE 13 k GRAVITY g 3.CONVENTIONAL SUCTION 0 4.SAFE SUCTION P3 CCR s 45 PRIMARY CONTAINMENT Ll 1.STEEL Nr4.FIBERGLASS 13 S.1 LxXML.E 0 10.RIGID PLASTIC 46 ❑ 90.NONE ❑ V.UNKNOWN ❑99. 464 SECONDARY CONTAINMENT 0 1.STEEL 4.FMERGL ASS o s.FwaBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE Cl V.UNKNOWN ❑ 99.OTHER ' k 464 PIPING(ITMI NE CONTAR04ENT SUMP TYPE IT 1.SINGLE WALL UIDOUBLE WALL 031 9a NONE 464 VL VENT,VAPOR RECO Y(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CON'T'AINMENT LI 1.STEEL W 4.FIBERGLASS 0 10.Rim R.ASRC 0 90.NONE 13 99.OTHER(Specify) 464 464e VENT SECONDARY CONTADMIE NT El I.STEEL C3 4.FIBERGLASS 13 10.RIGID PLASTIC 90.NONE 0 99.UTH6R(Specify) 46 4" VR PRIMARY CONTAINMENT El I.STEEL 4.111112AGLASS 13 10.RIGID PLASTIC 13 90.NONE 13 99.OTHER(Specify) 464 400 VR SECONDARY CONTAINMENT 0 L STEEL 0 4.FIBERGLASS 13 10.RIGID PLASTIC V 90.NONE 13 99.OTHER(Spo*) 464 4641, VENT PIPIIN(i TRANSITION SUMP TYPE SINGLE WAIL 2 DOUBLE WALL 90.NONE 461 RISER PRIMARY CONTA24ME NT W 1.STEEL U 4.FIBERGLASS U Ia RIGID PLASTIC U 90.NCNB 0 99.OTM(Spec(fy) 46 RISER SECONDARY CONTA4AK@1T 1.SIUL 13 4.FIDBRGLAS4 10.RIGID PLASrK V 90.NON1B E3 99.On m(Specify) 464 464 FILL CON901ENTS INSTALLED W 1.SPELL BUCKET 3.STRTICER PLATB/BowoM PROTECTOR rf CONTAINMENT SUMP 461& VII.UNDER DISPENSER CONTAINDAINT(UDC) CONSIAUCTIOIN TYPS Irl.SINGLE WALL0 2.DOUBLE WALL 0 3.NO Di t3 ❑ 90.NONE '' 46.9 CONsTRucnoN MATlIRlAL 0 1.STEEL 4.FIBER01" E3 la RIGID PLASTIC L3 99. ) 4696 VIII. CORROSION PROTECTION ST136L COWOMC PROTECTION ❑ 2.SACRIFICIAL.ANODH(S) ❑ 4.IMPlZS=CURRENT or&111OOLATION 44 Ix. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the kazardeus substance stored and that the informatlom provided kwaW is tree,acc arab and in&11 compliam WkIL legal requirements. APPLICANT SIGNATURE ;yyJ y 7-47 DATE JUNE 3,2009 }... . APPLICANT NAME(paint) Mi��[[e�• arvelot, 471. APPIICAm mnE DlnmWr, Environmeniad Affairs 47 for Quik Stop Markets Inc.