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iI " IFIED PROGRAM CONSOLIDATED FORM PR#: PR0231482 UNDERGROUND STORAGE TANKS -TANK PAGE FAC #: FA0000720 (twoages ertank) e2af7 TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 61MrOX16YSITE CLOSURE (CFack anly imn only) -. nh. 34 "'" i, ❑ 7 PERMANENTLY CLOSED ON S (Spmbrmsw fm I..) auoaly) (S 3RENEWAL PERMIT ' BTANK REMOVED 8 J5- D BUSINESS NAME (S2=0 FACILITYNAMEmNA. Doing Business Ao FACILITYID: PR#: I MADSEN'S SUNRISE DAIRY FA0000720 PR0231482 0 LOCATION WITHIN SITE(oni.h 239 S STOCKTON ST, RIPONq' � 431 PHONE I. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK M# Tank #: 4 432 TANK MANUFjkCTURER 431 COMPARTMENTALIZED TANK yes ❑ No 434 erN V)ej8,A 46; TA0504844 06 If"Yw", ea�Ige one pag for each wegarlmmc DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY INGALLONS 416 NUMBER OF COMPARTMENTS n 437 2-1-1-0 2,632 5 ADDITIONAL DESCRIPTION (F.tud..,,,n,) 439 H. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I. MOTOR VEHICLE FUEL 45.18. REGULAR UNLEADED [-12. LEADED ❑ 5. JET FUEL L f toukd wmplcle Pelmlc= Type) Ib. PREMIUM UNLEADED [-13. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ Ic. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME(Oom Hazardma Malmiab lmwlnrypa,) 441 CAS4(rmm3l0:mdom Materiab lmemmy page) a2 E-14. HAZARDOUS WASTE ft"tees Used Oil) ❑ 95. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check arc item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL - primary unk ❑ 1. BARE STEEL ❑ FIBERGLASS/ PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Chakaro iwn oNy) ❑ 2. STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC (FRP) ❑ 99 OTHER TANK MATERIAL - secondary, lank ❑ L BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 445 (Click meixm may) ❑ 2. STAINLESS STEEL 4. STEEL CLAD WNIBERGLASS ❑ 8. PEP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 99. OTHER ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 147 OR COATING ❑ 99. OTHER (Click om i..*) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED (Fmbnl a,e onb) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION E]41MPRESSEDCURRENT El 99 OTHER (Chckmmiutnonly) ❑ 2SACRIFICIAL ANODE (Pm bras ive only) YEAR INSTALLE450 TYPE(Ia Itec nly) 451 SPILL AND OVERFILL YEAR OVERFILL PROTECTION EQUIPMENT: YEAR MSTALLED 452 (kalldmlapply) KSa 1 SPILL CONTAINMENT 1,994.00 CFu QQNV ❑ IALARM �3FB.L TUBE SHUT OFF VAL`�_ �2 DROP TUBE I0Iy Cp AYInI ❑2BALL ❑4EXEMPT fA 3 STRIKER PLATE FLOAT IV. TANK LEAK DETECTION (A d mption orme monilnringpmwam stun bnsnbmbled u debrala9 y.) IF SINGLE WALL TANK (Ck all Wm appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 F1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check °"`"`"'only) ❑ 2AUTOMATIC TANK GAUGING (ATG) ❑ fiVADOSE ZONE ❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ® 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑ 3 MANUAL MONITORING (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OFSUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 451 ❑ Yes ❑ No UPCF (12/99 revised)