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�FIED PROGRAM CONSOLIDATED FORM `G o TANK: TAo505844 �/ PR#: PR 231330 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0603964 .Z (Iwo pages pet sank) TYPE OF ACTION ❑ 1NEW SITE PERMIT ❑ 4,1111\DDD PP:R,UI'I Pagc4 of5 ❑SCHANGE OF INFORMATION ❑bTEMPORARY SITE CLOSURE (Chink wily itnn on1Y) : r furl t ❑ PERMANENTLY CLOSED ON SITE E] (Sp y- t bcllaceouy) (Spmtyrmepu- S 3RENEWAL PERMIT y)�' ❑ TANK REMOVED 430 BUSINESS NAME(s MFACILTYNAMEMDBA- FACILITY ID: PR#: 1 LODI PUBLIC SAFETY BUILDING FA0003964 PR0231330 LOCATION WITHIN SITE(opsin ) 230 W ELM ST,LODI 431 PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including bWldings and landmarks shall be submued m the local ag=y.) TANK ID# Tank#: 4 432 TANK MANUFACTURER d13 1 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0505844 PERKINS WELDING SACRAMEN ItNm;complpcaspage fm eaeAmwmva DATE INSTALLED(YEAR/MO) 419 TANK CAPACITY IN GALLONS 416 NUMBER OF COMPARTMENTS 437 2,000 ADDITIONAL DESCRIPTION(Fm tical sae may) 438 EL TANK CONTENTS TANK USE 419 PETROLEUM TYPE a4o ® 1.MOTOR VEHICLE FUEL ❑ la REGULARUNLEADED ❑ 2.LEADED ❑ 5.JET FUEL 0f®ncMmopMcpgm4,o T? ) ❑ Ib.PREMIUM UNLEADED ® 3.DIESEL ❑b.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL ❑".OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(6mn H. M...E m�mtmy page) al CAS#(6um xaa mov Matcaialslmmlmy page) a42 ❑4.HAZARDOUS WASTE (Imran Uadoa) ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chak 9m fmm mJl) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ®2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tack ® I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Chink mrd®muy) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD WNIBERGLASS ❑ 8.FRP COMPTIBLE W/I00%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank 1.BARE STEEL 11-y3,pa'IBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (C3mY msilmn Dory) ❑ 2.STAINLESS STEEL 4.STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTISLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ RUBBER LINED 3EPDXY LINING 1. ❑ . a17 OR COATING ❑ S.GLASS LINING ❑95.UNKNOWN 445 DATE INSTALLED (ChNmcnrnody) 2ALKYD LINING ❑4PHENOLIC LINING ®6UNLINED ❑ 99 OTHER (Pmkal uuwy) OTHER CORROSION I MANUFACTURING CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED W9 PRO'T'ECTION U APPLICABLE PROTECTION (C OM ttw 9N39 ❑ 2SACRIFICIAL ANODE E]4 IMPRESSED CURRENT ❑99 OTHER (Fmknl ueaoy) SPILLANDOVERFD.LYEAR INSTALLE450 TYPE(Imal.. y) 451 OVERFILL PROTECTION EQUIP:YEAR INSTALLED 452 ft,(CTnk dl t appy) ""PILL CONTAINMENT ❑ IALARM 3 FILL TUBE SHUT OFF VAL` 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT ❑ 3STRIKER PLATE FLOAT N.TANK LEAK DETECTION(A dnmprim otNcmooilonnapmenmamn heap aw t.ae bwl aes y) TF SINGLE WALL TANK(Chmk au smalyry) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (CM1mk met�m�y) ❑ 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 ❑ S TANK TESTING E]3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 455 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑No UPCF(12/99 revised)