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..�FIED PROGRAM CONSOLIDATED FORM TANK: TA0506539 PR#: PRO506538 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0007116 o pages per tank) TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ aVblI�UIDNI:N>tIT I] S(IIyAt [a l'I IO IivI ATION Page29f5, (�wy�-*) ❑ 6 TEMPORARY SUE CLOSURE �y/y'��Li ❑ 3RENEWAL PERMIT r5pn ryruswr�t'orlm lNue wlyl vpccg mvscv�.rorlwilrxcrnlyt 7 PERMANENTLY CLOSED ON SITE 15❑ S TANK REMOVED /��••J// BUSMESSNAME(Smsn FACRIfYNAMEw DBA-Doing Brniness As) 1'ACILITY ID: PR X: 1 COUNTRY MARKETPLACE J FA0007486 PRO506538 LOCATION WITHIN!SITE(Opuu u) 1789 W CHARTER WAY,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location ofthe UST system including buildings and landmarks shall be submitted to the local agency.) TANK IDS Tank#: 1 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes [:]No 434 TA0506539 TRUSCO If'Ya'",catpine mrepage fw mfi mnpenrmrt DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 016 NUMBER OF COMPARTMENTS 437 2/27/1997 12,000 ADDITIONAL DESCRIPTION(Fwm mea,) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL 4w (fma -,Ine Pendnnn T,e) E) I b.PREMIUMUNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(Gwn Huwdau Mauniab hwmtwypage) a) CAS#giou, amdwnma ous Nvmtaypagc) ❑ 4.HAZARDOUS WASTE a2 ( dude Uawal) ❑95.UNKNOWN Ill.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Onh asitenmb) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-Primary tank ® I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN 444 (CLak mciam mbl ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(PRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Cb ttormly) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD WIRBERGLASS ❑ 8.FRPCOMPTIBLEW/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ RUBBER LINED 3EPDXY L I. ❑ . INING ❑ 5.GLASS!.MING ❑95.UNKNOWN p6 DATE INSTALLED N7 OR COATING (Cleckwcilanady) ❑ 2ALKYD LINING ❑ 4PHENOLIC LINING ® 6UNLINED ❑ 99.OTHER fFa local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC 449 PROTECTION IF APPLICABLE PROTECTION ® 3FIBERGLASS REINFORCED PLASTIC E] 95 UNKNOWN NB DATE INSTALLED (L.gny meiaa wrb) ❑ 41MPRESSEDCURRENf ❑ "OTHER ❑ 25ACRIPICIAL ANODE (Fw kN we ady) SPILL AND OVERFILL YEAR INS'TALLE450 TYPE(k,o0.eonb) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (a aadHta ly) ❑ I SPILL CONTAINMENT ❑ IALARM ❑ 2 DROP TUBE ❑ 3 FILL TUBE SHUT OFF VOL` ❑ 2BALLOEXEMPT F-1 FLOAT E]3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d.swiprim on6e moaitaiag Pros<anawn be amrnnd Wflwe lam!agrnq.) IF SINGLE WALL TANK(Qx k all dut Wb) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) E] 5 MANUAL TANK GAUGING(MTG) (e6erkmei..Iy) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YWMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 455 TANK FILL ED WITH INERT MATERIAL? 457 ❑Ycs ❑No UPCF(12/99 revised)