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NIFIED PROGRAM CONSOLIDATED FORD TANK: TA0508223 N.W, &jr PR#: PR0231511 UNDERGROUND STORAGE TANKS -TAN FAC#: FA0003695 a O (two pages per tank) Page 3 00 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 3 CHANGE OF INFORMATION b TEMPORARY SRE CLOSURE (CI}mtyitam wdy) ®® ®® PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT ❑STANK REMOVED uo BUSINESS NAME(Sure.FACB.DYNAME orDRA-Doing thaw.Ac) FACILITY ID: PR#: l 3 FA0003695 PR0231511 LOCATION WITHIN SITE(IlpgwW) 7611 S AIRPORT WAY,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landnvrks shall be suMmtted to the local agency.) TANK ID# Tank#: 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Y,,s ❑No 434 TA0508223 I XERXE$ B"Ym',caryks mewse rare„6 w,m.m�e DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 11/5/1998 12,000 ADDITIONAL DESCRIPTION(Fort-1 me amy) 438 D.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEWCLEFUEL ❑ Ia.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (IrmrkWm .Pm -Type) ❑ lb.PREMIUM UNLEADED ® 3.DIESEL ❑ b.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ is MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(6om H�&Ud i sIrvmn page) 441 CAS#(6am Havrame Materia6 hrvm[my page) 412 ❑4.HAZARDOUS WASTE mmluda Uaed an ❑ 95.UNKNOWN Ill.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SNGLE W ALL WITH ❑ S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM a3 (aurk mcitsn mN) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary mnk ❑ LBARESTEEL M FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 441 (Chskmcimnmly) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99 OTHER TANK MATERIAL-secondary tank ❑ I.BARESTEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN MS (Chak=nmordy) ❑2.STAINLESS STEEL ❑4.STEELCLADW/FIBERGLASS ❑ 8.FRPCOMPTIBLEW/100%METHANOL UNFORCED PLASTIC(FRP) ❑ H.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS FIXING E]95.UNKNOWN 446 DATE INSTALLED at OR COATING (CMk arc im only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Pwlod me only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS UNFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED a9 PROTECTION IF APPLICABLE PROTECTION (Chakancimn Myl ❑ 4 IMPRESSED CURRENT El 990THER [:] 25ACRIPICIAL ANODE (Fsbd ue mly) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(loml we mb) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 ❑ 1 SPILL CONTAINMENT 1,998.00 ❑ 1 ALARM ❑ 3 PILL TUBE SHUT OFF VALI ❑ 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A de.oiptlm orwn n skt gpsa 3m 11 he ssbmsn,dto the 1pol ag y.) IF SINGLE WALL TANK(Check.H dumpy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ i VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Clw&a nmi my) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ i VISUAL(SINGLE WALL IN VAULT ONLY) ❑3 CONTINUOUS ATG ❑ J GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SBR)BIENNIAL TANK TESTING ❑ 99 OTHER V.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? 451 11/5/1998 0.00 gallons ❑Yna ❑ No UPCF(12/99 revised)