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1FIED PROGRAM CONSOLIDATED FO' I %�, `/ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page 3 of 8 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one Rem only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-fo loeala only) (Spedfyr on-forlocalwemly) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same m FACILITY NAME ar DBA-Dein,Business As) 1 3FACILITY ID: ( 0 ? 0 0 0 0 0 0 0 0 0 Chevron Station#90557 LOCATION WITHIN SITE(Dptionap 431 139 S Center St.,Stockton,CA 95202 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.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes 0 No 434 2 JOOR If"Yea",conplete Doe page for each compertmem. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1/1/90 10,000 0 ADDITIONAL DESCRIPTION(F«ba ase aniy) 438 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE Ono ®1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL pfmarked corryMe Pevokam Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ®Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Haeardow Materials InwetM page) 441 CAS#(Ban Hw w Mareriak Inventory page) 442 ❑4. HAZARDOUS WASTE paludc Used a0 ❑95.UNKNOWN MID-GRADE UNLEADED 800-61-9 III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [13. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check ova Rem My) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL [14. SINGLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL-prhwry t 01. BARE STEEL 0 3. FIBERGLASS/PLASTIC ❑5. CONCRETE 0 95. UNKNOWN 444 (Check one Rem only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-x oahary twk ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 (Check o Rem only) ❑2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W1100%METHANOL ❑99.OTHER REINFORCED PLASTIC(IRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LIMING ❑1.RUBBER LIMED ❑3.EPDXY LINING USK.GLASS LINING ❑95.UNKNOWN a6 DATE INSTALLED 447 OR COATING ❑2 ALKYD LR41NG ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Check arc Rem only) (For Inial ase only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN a4, sag PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (peck won Rem Dory) ❑2 SACRIFICIAL ANODE (Por bwl uu only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local.,.only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ®3 FILL TUBE SHUT OFF VALVE ®1 SPILL CONTAINMENT 1990 ®1 ALARM OPW 61-SO-4 ®2 DROP TUBE 1998 OP W 61-SO4 ❑2 BALL FLOAT _ ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf _ IV.TANK LEAK DETECTION(A desc*ion ofthe t horing Mm slall be submitted w the local agency) IF SINGLE WALL TANK(Check all tom*Py) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check oat Rem ody) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.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 gallons ❑Yes ❑ No UPCF(1/99 revised) 175 Formerly SWRCB FonnB