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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT , UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYTE OF ACTION (Check one item only. For an UST perrnanen closure or removal,completeonly this section and Sections I,II,III,IV,and IX below) 430 (f( 1.NEW WAWT F6" ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4304 1 DATE EXISTING UST DISCOVERED: 430b L FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 UIK STOP MARKET#144 BUSINESS SITE ADDRESS 103 CITY 164 7272 WEST LANE STOCKTON II.`TANK DESCRIPTION TANK ID# rJJ-y r'� G t. ,432 TANK MANUFACTURER 437 TANjC CONFIGURATION: THIS TANK IS 414 #3(Prem.Unl., 91 OCTANE OWENS-CORNING C]El. .ONE IN STAND-ALONE COMPARTMENTED UNIT. 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 JANUARY 26,1988 8,000 1 III.TANKUSE AND.CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.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: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED jr1b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440& NON-PETROLEUM:0 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406 ID. TANK'C0NStR9CTI0N TYPE OF TANK Lj L SINGLE WALL Wg.DOUBLEWALL Ll 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS U 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERN WING C195.UNKNOWN El ".OTHER (Specify): 4449 AL SECONDARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify) 4459 OVERFILL PREVENTION 0 1.AUDIBLE 8t VISUAL ALARMS Lj 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT O. PRODUCT!WASTE PIPING.'CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED 2.DOUBLE-WALLED L]99.OTHER 460 SYSTEM TYPE 1.PRESSURE ❑ 2.GRAVITY Lj 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR 42636(&x3)) 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 i ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a I SECONDARY CONTAINMENT ❑ 1.STEEL jr4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING111MINE CONTAINMENT SUMP TYPE WI.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(DR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT Ll 1.STEEL N 4.FIBERGLASS U 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Specify) 464e 464el VENT SECONDARY CONTAINMENT 1.STEEL 0 4.FIBERGLASS El 10.RIGID PLASTIC 90.NONE El 99.OTHER(Specify) 464f 464fl VR PRIMARY CONTAINMENT 1,STEEL4.FIBERGLASS 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify) 4648 4 VR SECONDARY CONTAINMENT C1 1.STEEL 0 4.FIBERGLASS 0 10.RIGID PLASTIC W10.NONE ❑ 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE C3 1.SINGLE WALL C1 2.DOUBLE WALL 90.NONE 4641. RISER PRIMARY CONTAINMENT W 1.STEEL U 4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Specify) 464j 464i 1 RISER SECONDARY CONTAINMENT 0 1.STEEL 4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE C1 99.OTHER(Specify) 464k 4641 FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRucER PLATFJBOTTOM PROTECTOR4.CONTAINMENT SUMP 451&c VQ..UNDER DISPENSER CONTAINNIDNT'(UDC)?.. . w . CONSTRUCTION TYPE jr 1.SINGLE WALL ❑ 2.DOUBLE WALL [13.NO DISPENSERS ❑ 90.NONE 469& CONSTRUCTION MATERIAL ❑ 1.STEEL C FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99,OTHER(Specify) eay. . ,:,., 4696-c ,VIII. ;CORROSIONvPROTECTIOI�t . STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT6.ISOLATION 448, • ' ' ;`�` .x . � �'APPI.7CANT°SIC4NATIIREf _ CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is ue,accurate, and in full compliance with.itgal requirements. APPLICANT SIGNATURE DATE September 1, 2009 470 APPLICANT NAME(print) Mike Karvelot, 471" APPLICANT TITLE Director, Environmental A airs 472. for Quik Stop Markets,Inc. UPCF UST-11-1/2 Rev.(12/2007)