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It ' FIED PROGRAM CONSOLIDATED FORMjf PR#: PR0231482 UNDERGROUND STORAGE TANKS - TANK PAGE FAC #: FA0000720 (tw pages per tank) 6 TYPE OF ACTION ❑ 1NEW SITE PERMIT ❑ YAMENDED PERMIT ❑ SCHANGE OF ❑ 6TEMPORARYSITE REe (CTxk oNyilan oNy) - ❑ ]PERMANENTLY CLOSED O SITE (Specify 6rItcu cpoly) (Spcity.-PnI.I.sey). 3 RENEWAL PERMIT FAIeTANK REMOVED !eash o BUSINESS NAME(Sanw as FACILITY NAME w DBA- Doing Business As) FACILCIY ID: PR tt: MADSEN'S SUNRISE DAIRY 3 FA0000720 PR0231482 LOCATION WITHIN SITE (opdaw) 239 S STOCKTON ST, RIPON 431 PHONE 1. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANKIDN Tank #: 6 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes ❑ No 434 TA0504846 MODERN WELDING CO IVY.'. wWlnc wepage fweaehwsry steeeet. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 437 -{ 2,632 ADDITIONAL DESCRIPTION (Fwloca ue oey) 438 D. TANK CONTENTS TANK USE 4J9 PETROLEUM TYPE uo ® I. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL QOsmItWwWletc Pclmlenn Type) ❑ Ib. PREMIUM UNLEADED ® 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ It. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (awn wra,dnw Mwcials issete,,pege) 441 CAS#(ww Namdom MTaiatsImmwry page) 442 ❑ 4. HAZARDOUS WASTE (mwet Used on) ❑ 95. UNKNOWN M. TANK CONSTRUCTION TYPE OF TANK ❑ I. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cackem man ony) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER TANK MATERIA. - priamy tank ❑ I. BARE STEEL ❑ FIBERGLASS/ PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Click oe new way) ❑ 2. STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/ 100% METHANOL REINFORCED PLASTIC (I") ❑ 99. OTHER TANK MATERIAL - secondary tank ❑ I. BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95. UNKNOWN 445 (Chale am I= only) ❑ 2. STAINLESS STEEL �C$. STEEL CLAD W/FIBERGLASS ❑ I. FRP COMPTIBLE W/100% METHANOL REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ MOTHER ❑ 5. CONCRETE TANK INTERIOR LINING ❑ I. RUBBER LINED ❑ 3. EPDXY LINING447 ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED OR COATING ❑ 99. OTHER (Click=it= only) ❑ 2ALKYD LINING ❑ 4PHENOLIC LINING ® 6UNLINED (PwbW me wly) OTHERCORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN -8 DATEINSTALLED a9 PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER (C kweaemunly) F1 25ACRIFICIAL ANODE (Pwloul wcany) SPILL AND OVERFILLYEARYEAR INSTALLE450 TYPE(Iwduseony) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 Cas (k all mat appy)V1 ) I SPILL CONTAINMENT �� ❑ I ALARM X 3 FILL TUBE SHUT OFF VAL` K.2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT �r 2} 3 STRIKER PLATE FLOAT TV. TANK LEAK DETECTION (A aucptioner ae eoNwrmq pw4 aanb sw summa 11agwny.) IF SINGLE WALL TANK(Clek an ast mply) 453 IF DOUBLE WALL TANK ORTANK WITH BLADDER 454 ❑ I VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chckon.i oely) ❑ 2 AUTOMATIC TANK GAUGING (ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG [-17 GROUNDWATER ® 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑ 3 MANUAL MONITORING (SIR) BIENNIAL TANK TESTING F1 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) F271