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'IFIED PROGRAM CONSOLIDATED FO- I �- S../ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Pane 7.f 8 TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one nem only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specifyrcaeme-forlocaloreenly) (Spccifyremon-fimloceluscanly) ❑ 8 TANKREMOVED 430 BUSINESS NAME(same a FACILITY NAMB or DBA-Doing Business As) 3 FACILITY ID: 0 0 0 0 0 0 0 0 0 0 0 1 Chevron Station#90557 LOCATION WITHIN SITE(optimoo 431 139 S Center St., Stockton,CA 95202 1.TANK DESCRIPTION (A scaled plot plan with the location of[he 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 4 JOOR If•Yea",compine one page for each com eirts ent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1/1/90 1000 0 ADDITIONAL DESCRIPTION(For loeal age only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ❑I. MOTOR VEHICLE FUEL ❑la. REGULARUNLEADED ❑2. LEADED ❑5. JET FUEL (If markedrarrylece Petrolmon Type) ❑16. PREMIUM UNLEADED [13. DIESEL [16. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADEUNLEADED ❑4. GASOHOL ®99.OTHER 03. CHEMICAL PRODUCT COMMON NAME (Som Hamrdone metereats inventory page) Ml CAS#(Som Haaerdoua Matenals Inventory page) 442 ®4. HAZARDOUS WASTE (1.1w.Uud oil) USED MOTOR OIL N/A ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chockomitemonly) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ®2. DOUBLE WALL ❑4. SINGLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-prbrarytack ®1. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE 0 95. UNKNOWN 444 (Check one nem only) ❑2. STAINLESS STEEL [14, STEEL CLAD W/FIBERGLASS ❑8. PRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tmdc ❑1. BARE STEEL El 3. FIBERGLASS/PLASTIC 0 5. CONCRETE ❑95. UNKNOWN 445 (Check one nem only) ❑2. STAINLESS STEEL 04. 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 N7 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Check me,nem only) (For Imol one only) Y OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 44a as PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one nem only) ❑2 SACRIFICIAL ANODE (For kral use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ®1 ALARM Veeder-Root ❑3 FILL TUBE SHUT OFF VALVE ®1 SPILL CONTAINMENT 1990 Hiah Level Sensor ❑2 DROP TUBE ❑2 BALL FLOAT M 4 EXEMPT ®3 STRIKER PLATE Tank Mf IV.TANK LEAK DETECTION(A deneripnon of the monitoring program shall be submittw to the local agency.) IF SINGLE WALL TANK(Checkatt that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 054 (Chock one item only) ❑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) 179 `,/ Formerly SWRCB Form B