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— —r to T� oc-\ FLED PROGRAM CONSOLIDATED FORn"a 3 p TANK: TA0505844 PR#: PRO231330 �5 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0003964 (two pages per tank) TYPE OF ACTION ❑ i NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑5 CHANGE OF INFORMATION ❑6 TEMPORARY SITE CLOSURE Page 4 of 5 (CMxt nndynnn Dory) ❑?PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT _ ❑STANK REMOVED ao BUSINESS NAME(S as FACILITY NAME m DBA-Doing B.mxsa Aa) FACILITY ID: pR#; 1 LODI PUBLIC SAFETY BUILDING FA0003964 PR0231330 LOCATION WITHIN SITE(optiee0 230 W ELM ST,LODI 431 PHONE I.TANK DESCRIPTION(A scaled plot plans with the location of the UST system imluding buildings and landmarks shall be subrttimd to the local agency.) TANK IDN Tank#: 4 43g TANK MANUFACTURER433 COMPARTMENTALIZED TANK ❑Yes E]No 4J4 TA0505844 PERKINS WELDING SACRAMEN H'Ye*.mmpldeowpegefwcwemmpn0oml. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS U6 NUMBER OF COMPARTMENTS d37 2,000 ADDITIONAL DESCRIPTION(Fwlaol we®y) 439 D.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ❑ Ia.REGULARUNLEADFD ❑2.LEADED ❑5.3ET FUEL Rfvartm ewryMe Pamken Typc) ❑ Ib.PREMIUM UNLEADED ® 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ le MIDGRADEUNLEADED ❑ 4.GASOHOL El 3.CHEMICAL PRODUCT ❑99.OTHER COMMON NAME(rtow xaePme Mani.I.Immmryp,ge) 441 CAS#(rww Ha:a mu:M.lma6lm9mwy Page) a2 ❑4.HAZARDOUS WASTE (Include u.W On) Cl 95.UNKNOWN 111.TANK CONSTRUCTION TYPEOFTANK I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM43 (Orcek mmile�onlyj EXTERIOR MEMBRANE LINER ❑95.UNKNOWN ® 2.DOUBLE WALL Ll4.SINGLE WALL IN VAULT ❑99.OTHER TANK MATERIAL-primary tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC El5.CONCRETE E195.UNKNOWN 444 (Clark meilan onl) r Y ❑ 2.STAINLESS STEEL El CLAD W/FIBERGLASS ❑ B.FRP COMPTIBLE W/I00%METHANOL ' REINFORCED PLASTIC(FRP) El99.OTHER TANK MATERIAL-secondary tank EeBARE STEEL ❑ IBERGLASS/PLASTIC ❑ 5.CONCRETE [195.UNKNOWN 445 (C(ct—itwody) ❑ 2.STAINLESS STEEL JF4.STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(I") ❑ IO.COATEDSTEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING OR COATING ❑ I.RUBBER LINED ❑3.EPDXY LINING ❑ S.GLASS LINING El 95- 446 DATE MSTALf1iD 447 (C6wk one it..1y) 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED E199.OTHER (Pwb aacmly) OTHER CCORROSION I PROTECTION MANUFACTURING CATHODIC PROTECTION IFAPPLICABLE PROTECTIEl ❑3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN 449 DATE INSTALLED u9 (Chek one itan aoy) El IMPRESSED CURRENT ❑99 OTHER El 2 SACRIFICIAI.ANODE (pwmtuveany) SPILL AND OVERFILL YEAR INSTALLE450 TWE(loealweony) 451 OVERFILL PROTECTION EQUIPM�7E/�T:YEARINSTALLED 452 (CTck a dutappy) PD1,CONTAINMENT ElI ALARM .�j' 3 FILL TUBE SHUT OFF VAL` ROP TUBE ❑ 2BALL ❑4EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A dusipdan oft6a aaa t i ngpragnmstill beaubnmledto Nelaal ageay.) IF SINGLE WALL TANK(eeek an am appy) 453 IF DOUBLE WALL TANK ORTANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (C6wkeien®Dory) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6VADOSE ZONE ❑ I VISUAL(SINGLE WALL M VAULT ONLY) ❑3 CONTINUOUS ATG ❑ 7 GROUNDWATER 912 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑99 OTHER ❑3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/M0/DA1) 455 ESTIMATED QUANTRY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 3 3 S $ ❑Yes ❑No UPCF(12/99 revised)