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-FIED PROGRAM CONSOLIDATED FORM (SIP-TANK: TA0515781 PRO: PRO524210 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC O: FA0016254 (two pages per tank) TYPE OF ACTION Page 2 of 3 (Chwk mvhmi mh) ❑ INEW SITE PERMIT ❑4AMENDED PERMIT ❑ SCHANGE OF INFORMATION ❑ bTEMPORARY SITE CLOSURE (SPwQ fm ford uu oM) ' Ispw[y -fmI stuuon ❑ 7 PERMANENTLY CLOSED ON SITE El RENEWAI.PERMIT b) 8TANKREMOVED 430 BUSINESS NAME(suwss FACIImNAME w DRA-DONS e„aims As) FACILITY ID: PRN; 1 TRACY,CITY OF 3 FA0016254 PR0524210 LOCATION WITHIN SI I h(Op000m) 619 CENTRAL AVE,TRACY 431 PHONE I.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# Tank 0: I 43z TANK MANUFACTURER 433 I COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0515781 if Y.-'Ow„plwewa Pae¢r r+Po. amsa t. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 435 NUMBER OF COMPARTMENTS 437 500 ADDITIONAL DESCRIPTION(Fw Iwal asaw05) 438 EL TANK CONTENTS TANK USE 439 PETROLEUM TYPE ❑ 1.MOTOR VEHICLE FUEL ❑ la REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL ufmua]m IhPpm.Tau) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL M 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME awn H.&to Maaedala Imwmawy ❑4.HAZARDOUS WASTE ( Pau) all CAS#(6om H Wwas Maimela mumory page) 412 (haN uwd a) ® 95.UNKNOWN RI.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CFeak ae ima mN) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ❑ Z DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ IBARE STEEL ❑ FIBERGLASS/PLASTIC [15 CONCRETE ❑ 95.UNKNOWN 4" (Ch Y wrz u®w�le1 ❑ Z STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/I"K METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (CAwk wu i�anry) ❑2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100'6 METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING 5.GLASS LINING 447 OR COATING ❑ ❑95.UNKNOWN 446 DATE INSTALLED (Oh -am a ) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑ 99.OTHER (Fw bul we mty) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3FIBERGLASS REINFORCED PLASTIC95 UNKNOWN 448 DATEINSTALLED aa9 PROTECTION IF APPLICABLE PROTECTION ❑ (Chw ..mnwh) 2SACRIFICW.ANODE E]4 IMPRESSED CURRENT ❑ WOTHER ❑ (Fw brd uae my) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(Iwe1 aae a b) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (CIUPk dl Net apph) ❑ I SPILL CONTAINMENT ❑ I ALARM ❑3 FILL TUBE SHUT OFF VAL` ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT TV.TANK LEAK DETECTION(A da Moon Ofoa nwNmriOe p,,am.ean be aubntind to ma kOil.Puas.1 IF SINGLE WALL TANK(Ch AOat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Cask wu iten o*) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK 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 QDANTITY OF SUBSTANCE REMAINING 455 TANK FILLED WITH INERT MATERIALS 457 6/9/2005 12:0O:OOAM 0.00 gallons ❑ Yes E]No UPCF(12/99 revised)