COMPLIANCE INFO_2008-2012 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT i!f UNDERGROUND STORAGE TANK l0 OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYgE OF ACTION (Check one item only. For an UST permanert closure or removal,completeonly this section and Sections I,I1,III,IV,and IX below) alo R'L NEW PELF IvOR s+1 ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4308 I DATE EXISTING UST DISCOVERED: 4306 L FACILITY,INFORMATION FACILITY ID#(Agency Use Only) _ _ � r 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 UIK STOP MARKET#144 BUSINESS SITE ADDRESS 103 1 CITY 104 7272 WEST LANE STOCKTON IL TANK DESCRIP 011 TANK ID# ;', G(�� 2 TANK MANUFACTURER 437 TAN)c CONFIGURATION: THIS TANK IS 434 #1 (RUL,87 OCTANE) OWENS-CORNING I.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Com fete one page for each com-trnent in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT -037 JANUARY 26,1988 10,000 1 IM TANK USE AND CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439' CONTENTS PETROLEUM: Wll..REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.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-PETROLEUM(Specify): 4406 IV..TANK;:CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL r2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL Wr3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL VNING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL 21.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify) 4458 OVERFILL PREVENTION 0 1.AUDIBLE&VISUAL ALARMS U 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V.'PRODUCT/WASTE PIPING CONSIMUCTION , PIPING CONSTRUCTION ❑I.SINGLE-WALLED W2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY Ll 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(.x3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL V4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGfrURBINE CONTAINMENT SUMP TYPE Irl.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VI.VENT,VAPOR RECOVERY(VR)AND RISER-/F1L ePIPE PIPING CONS TRUtr'[' ON VENT PRIMARY CONTAINMENT ❑ 1.STEEL Ork FIBERGLASS Ej 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464e 464ei VENT SECONDARY CONTAINMENT F3 STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 461`1 ME 46411 VR PRIMARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify) 4648 464 l VR SECONDARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC Ir 90.NONE 0 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL 0 2.DOUBLE WALL ir9O.NONE 464i. RISER PRIMARY CONTAINMENT Irl,STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE Lj 99.OTHER(Specify) 4641 464i 1 RISER SECONDARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC S10.NONE 99.OTHER(Specify) 464k 464k1 FILL COMPONENTS INSTALLER Orl.SPILLBUCKET Wr3.STRIKER PLATE/BOTTOM PROTECTOR rfCONTAINIAENTSUMP09 451e-e VII.UNDERDISPENSER COWONMF1N'T(UDC) CONSTRUCTION TYPE Wrl.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE "';' 469a CONSTRUCTION MATERIAL ❑ 1.STEEL Jrk FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469b-c a . VIIEt CORROSION PROTBC7'ION STEEL COMPONENT PROTECTION C12.SACRIFICIAL ANODE(S) [14.IMPRESSED CURRENT 6.ISOLATION 448 'IIC.t, PP`LICAIT'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 witjk legal requirements. APPLICANT SIGNATURE DATE September 1, 2009 azo. APPLICANT NAME(print) Mike Karvelot, 471. APPLICANT TITLE Director, Environmental Affai 472. for Quik Stop Markets,Inc. UPCF UST-B-1/2 Rev.(122007)