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` FIED PROGRAM CONSOLIDATED FORMANK: TA05oag45 PR #: PRO231482 UNDERGROUND STORAGE TANKS - TANK PAGE FAC #: FA0000720 (t o pages per tank) ege 4 of 7 TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Clark only ha^ only) - '- 4 ❑ 7 PERMANENTLY CLO ON 1TE 3 RENEWAL PERMPERMIT(Spmf>rcawn. for laial mcooly)� (Sp<n[y,v4m-fmbwlm<oNy): IK48TANK REMOVED 03450 13USINESS NAME(Sawas FAULITYNAME MORA -Doing Bminces Aa) FACILITY ID: PR#: 'L ' MADSEN'S SUNRISE DAIRY FA0000720 PR0231482 LL LOCATION WITHIN SITE (optioap 239 S STOCKTON ST, RIPON 1 451 �99 PHONE 31)ks 1. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be subrmtted to the local agency.) TANK ID# Tank#: 5 452 TANK MANUFACTURER411 COMPARTMENTALIZED TANK xYes E] No 434 P� TA0504845 MODERN WELDING CO If•Ye.<a,nplac<n<Pag<fo«a<h<omparmen DATE INSTALLED (YEAR/MO) 455 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS ^ 437 (-7- 41 Ll 6,768 S ADDITIONAL DESCRIPTION (Fmloal me only) 438 O. TANK CONTENTS TANKUSE 439 PETROLEUM TYPE "a M L MOTOR VEHICLE FUEL ® I. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL pfmarkedw�ldc pcnoMm Tyyc) ❑ Ib. PREMIUM UNLEADED ❑ 3. DIESEL ❑ b. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ Ic. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME(6om Haardom Mareials Inventory page) Mt CAS#(fmm Haard<m Mabiils lnvenlory page) 442 ❑ 4. HAZARDOUS WASTE (IMlwe, Wait On ❑ 95. UNKNOWN M. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chale om km mJy) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL -primary rank ❑ I. BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Cluck mu iraNy) ❑ 2. STAINLESS STEEL in STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/ 100-A METHANOL REINFORCED PLASTIC (FRP) ❑ 99. OTHER TANK MATERIAL - secondary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ S. CONCRETE ❑ 95. UNKNOWN 445 (Chakom imn Doty) ❑ 2. STAINLESS STEEL 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/100% METHANOL REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 99. OTHER ❑ 5. CONCRETE TANK INTERIOR LINING ❑ I. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING 4 PHENOLIC LINING In b UNLINED -] 99.OTHER (Chakom 0mi only) ❑ 2 ALKYD LINING E]LI (Fmlaal m<oiJy) OTHERCORROSION ❑ I MANUFACTURING CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC E] 95 UNKNOWN 448 DATEMSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 4IMPRESSED CURRENT E]99OTHER (Chakme hanoeb) ❑ 25ACRIFICIAL ANODE (P<rl<ul me wly) SPILL AND OVERFILL YEAR INSTALLE450 TYPEoowlm<mdy) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 1 SPILL CONTAINMENT g49N Jut M 4D ( ElI ALARM 3 FILL TUBE SHUT OFF VAL` ((luck all apply) DROP TUBE 7a OIS a �3 ❑ 2 BALL ❑ 4 EXEMPT STRIKERPLATE �O�GI=� FLOAT TV. TANK LEAK DETECTION (A davipd<nofJu moniwringpro,r aha]] bnaabadnea w Ju local agency.) IF SINGLE WALL TANK(Cbah all Jin apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chink meI=only) ❑2AUTOMATIC TANK GAUGING INTO) ❑ b VADOSE ZONE ❑ I 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 OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑ Yes ❑ No UPCF (12/99 revised)