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�FIED PROGRAM CONSOLIDATED FORM TANK: TA0187202 /T) PH#: PR0231872 UNDERGROUND STORAGE TANKS - TANK (/2^/ � FAC#: FA0003967 1 t�^'J I (two pages per tank) Page 2 of TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4A.MENDEDPFRMII ❑ 5(II-0NGI OFISFORN1SCION ❑ 6TEMPORARYSITE CLOSURE (C3a<t my imo ony) (Spcdfy,.-rw.Iooa.ony) (SPm�yr i1on],r®aom ❑ 7 PERMANENTLY CLOSED ON SITE 3RENEWAL PERMIT ❑STANK REMOVED 430 BUSINESS NAME(Sn FACILITY NAME w DBA-Doing Buol oAt) FACILITY ID: PR#: 1 ,r 0 PACIFIC BELL 3 FA0003967 PR0231872 LOCATION WITHIN SITE(opdm0 7644 N ASHLEY LN,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted W the local agency.) TANK ON Tank#: 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0187202 lr^vo,mavlHa orcpagc rm.a<a maa>.mmc DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 \!)� 1 500 ADDITIONAL DESCRIPTION0mlmla.r my) 438 \ /7 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE40 ® I.MOTOR VEHICLE FUEL Ella.REGULAR UNLEADED E] 2.LEADED ❑ S.JET FUEL ` (If m cmglec Pwola Trt ) ❑ Ib.PREMIUM UNLEADED M 3.DIESEL ❑ &AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL ❑ W.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(bom H.vrdou.M to blmmmrypagc) I4I CAS#(rrom Huarmw Mmmalslmmmypage) 442 ❑4.HAZARDOUS WASTE fooW us Oa) ❑95.UNKNOWN Qt.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH [15.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (C kma non my) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑".OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL ❑FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 114 (Clackoocilvnooly) ❑ 2.STAINLESS STEEL E] STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN a5 (Cork me inn mly) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ S.CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 416 DATE INSTALLED 447 OR COATING (C me iuon ony) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ❑ 99.OTHER (For hal uaeody) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC E:1 95 UNKNOWN 44s DATE INSTALLED b9 PROTECTION IF APPLICABLE PROTECTION (Chu.kmtady) ❑4 IMPRESSED CURRENT El 99 OTHER ❑ 2SACRIFICW.ANODE (Forbwl ucmy) SPILL AND OVERFILL YEAR INSTALLE450 TYPEOo luwmy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Clck all rM1a appy) ❑ 1 SPILL CONTAINMENT ❑ I ALARM ❑ 3 FILL TUBE SHUT OFF VAL` ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A dco,,tim or da m totes pro,000 smabc submiUol tome 1m.1 asm.y) IF SINGLE WALL TANK(C1 91 nota y) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ( "km`ttO999y) ❑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 ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED( O/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 IM ❑Yes ❑ No UPCF(12/99 revised)