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'IFIED PROGRAM CONSOLIDATED FO- I ,%-W 1./ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) P.,5 of e TYPE OF ACTION ❑1 NEW SITE PERMIT [14 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one ft m only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Slccifyrcaoo-fwlacaluaawIY) (Spcciryreason-forkcaluseonly) ❑ 8 TANK REMOVED 430 BUSINESS NAME(same m FACILITY NAMB a DBA-Wing Basinaa As) 1 3 FACILITY ID: () 0 0 0 0 0 0 0 0 0 0 Chevron Station#90557 LOCATION WITHIN SITE(ogbnap 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 MANUFACTURER4 33 COMPARTMENTALIZED TANK Yes No 434 3 JOOR If"Yes',wnvk one page for each corryatmem- DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1/1/90 10,000 0 ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 448 ®1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ifmmkcd wnPlote Pelrokmn Typo) ®Ib. PREMIUM UNLEADED ❑3. DIESEL 06. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (thmn Haaadow Maerals Insntory page) 441 CAS#(gom Racadous Malcnals i..tory page) 442 ❑4. HAZARDOUS WASTE (I.W.Usaa Oil) PREMIUM UNLEADED 800-61-9 ❑95.UNKNOWN M. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL 3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check me nem only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN N 2. DOUBLE WALL ❑4. SINGLE WALLIN VAULT ❑99. OTHER_ TANK MATERIAL-prmury tank 01. BARE STEEL 03. FIBERGLASS/PLASTIC 0 5. CONCRETE 95. UNKNOWN 404 (Check one nem only) [12. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPATIBLE W/100°h METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-,.a.Iycoals 0 1. BARE STEEL 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN 445 (Check orc ft.only) ❑2. STAINLESS STEEL ®4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING 0 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Check one acro only) (For kcal use only) OTHER CORROSION ❑I MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 Me PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER (Check one am only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(,cal ose only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all tbw apply) ®3 FILL TUBE SHUT OFF VALVE ®1 SPILL CONTAINMENT 1990 ®I ALARM OPW 61-SO-4 ®2 DROP TUBE 1998 OP W 61-SO-4 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf IV.TANK LEAK DETECTION(A description oftlhc rronaoring program mall be submntedoo the local agency) IF SINGLE WALL TANK(Check all that apply) 453 IF ROUBLE WALL TANK OR TANK WITH BLADDER 454 (Check ore acmoaly) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑I VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ASO ❑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) 055 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) 177 Formerly SWRCB Form B