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JFIED PROGRAM CONSOLIDATED FORMTANK: TA0506540 PR#: PR0506538 UNDERGROUND STORAGE TANKS - TANK PAGW1FAC#: FA0007486 (two pages per tank) TYPE OF ACTION Pagc 4 5 ❑ 1 NEW SITE PERMIT ❑0 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE W� (CMk only hent wy) ❑ 7 PERMANENTLY CLOSED ON SITE ❑3RENEWAL PERMIT ❑STANK REMOVED 430 BUSINESS NAME(Sms u FAcaIIYNAsIE w DBA-Dom,Blomen As) FACILITY ID: PR N: l COUNTRY MARKETPLACE FA0007486 PR0506538 LOCATION WITHIN SITE(op k-o 1789 W CHARTER WAY,STOCKTON 431 PHONE 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# Tank#: 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0506540 TRUSCO If'Ya",cwryku wepagc for wd1 cwrvarmanl. DATE INSTALLED(YEAR/MO) 435TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 2/27/1997 20,000 ADDITIONAL DESCRIPTION(Fm local lncwy) 439 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ® I..REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL pf-,kedm lempeauletvn"pye) ❑ lb.PREMIUMUNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(ban Havrdwu Ma onta m,wee,,w) al CAS#(fiwnwnNmu Maedels(menu,page) 442 ❑4.HAZARDOUS WASTE (wo4c,Uad Oa) ❑ 95.UNKNOWN IL.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Clckas hwnwy) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ® I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (C7 eoeitan Wy) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Ch-itwnwly) ❑ 2.STAINLESS STEEL ❑4.STEEL CLADWNIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED a47 OR COATING (Clck we iron wy) ❑ 2ALKYD LINING ❑ 4PHENOLIC LINING ® 6UNLINED ❑ 99.OTHER (Fa local we only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN US DATE INSTALLED 009 PROTECTION IF APPLICABLE PROTECTION (L7rrk weimn Wy) ❑ 41MPRESSED CURRENT ❑ 99 OTHER ❑ 25ACRIFICIAL ANODE (Eamon me wy) SPILL AND OVERFILL YEAR INSTAL1,E450 TYPE(Iwdme wy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 Iarod ill Mn wpy) ❑ 1 SPILL CONTAINMENT 1,997,00 ❑ IALARM ❑ 3 FILL TUBE SHUT OFF VAL` ❑ 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A dewiptiw oftne,wmtw;ngpmgonewl ne wbnuned to the Iwai a,ewy.) IF SINGLE WALL TANK(Chwi all dm Wly) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Llark we 1mn WY) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIA.MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ "OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL 457 E]Yes ❑ No UPCF(12/99 revised)