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l MED PROGRAM CONSOLIDATED FORM ANx: rw0133003 ✓ I PR#: PRO231330 UNDERGROUND STORAGE TANKS -TANK PA I FAC#: FA0003964 y 3 03 (two pages per tank) TYPE OF ACTION ❑ 1NEW SITE PERMIT ❑ 4AMENDED PERMIT.y it vny) ❑ SCHANGE OF INFORMATION ❑ 67EMPORARY SITE CLOSURE _ " .. ;' ❑ 7 PERMANENTLY CLOSED ON SITE ❑3RENEWAL PERMIT (SP=eJrS TOrbcei us Nvl (*drytgsw-fn loci ry) A ❑8TANK REMOVED 430 BUSINESS NAME($men FACRITY NAME Q DBA-Poing Bwiros As) FACILITY ID: pR#: t LODI PUBLIC SAFETY BUILDING 31 FA00039f I PR0231330 LOCATION WITHIN SITE(o W) 230 W ELM ST,LODI al PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location otihe UST syskm including bw7dings and lanMmrks shop be suhrmned to Ole Io;al agelcy.) TANK ID# rank#: 3 4J2 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0133003 PERKINS WELDING SACRAMEN 1r Yo',®pw w p g m,nm�np„a ea DATE INSTALLED,YEAR/MO) 435 TANK CAPACITY IN GALLONS 4336 NUMBER OF COMPARTMENTS 43) 12.000 ADDITIONAL DESCRIPTION(Fwloul nc Wy) 439 H.TANK CONTENTS TANK USE 439 P OLEUM TYPE ® 1.MOTOR VEHICLE FUEL la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL sW pr�akra wnPwe earolean rSPe) y ❑ Ib.PREMNM UNLEADED t�1p 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑ 3.CHEMICAL PRODUCT ❑ 4.GASOHOL ❑ 99.OTHER COMMON NAME(m xamsmn M.leiaw mvmnryg8e) 141 CAS#(aom xasasmw Matcmis lmeto page) 443 F1 4.HAZARDOUS WASTE (IrcIa UsMOa) ❑95.UNKNOWN ID.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (r,Txkercimnony) EXTERIOR MEMBRANE LINER 095.UNKNOWN ®2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT [:199.OTHER TANK MATERIA.-prin s,tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN a44 lChxk oM/mnnnN) ❑2.STAINLESS STEEL E] STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPT®LE W/I00%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary taM LBARE STEEL ❑ ERGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN 445 (caeaaK can Dory) ❑ 2.STAINLESS STEEL 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL 7 REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ ".OTHER , ❑ 5.CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED 3.EPDXY LINING OR COATING ❑ ❑ 5.GLASS LINING ❑95.UNKNOWN H6 DATE INSTALLED 447 (CMt onei�®y) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑ 99.OTHER (Pe lonl neaJy) OTHER CORROSION I MANUFACTURING CATHODIC ❑ 3FIBERGLASSREINFORCED PLASTIC ❑95 UNKNOWN H8 DATE INSTALLED M9 PROTECTION IF APPLICABLE PROTECTION (CMsko ..nl3.) ❑ 4 IMPRESSED CURRENT El "OTHER [:12 SACRIFICIAL ANODE (Fabmt nc e8y) SPILL AND OVERFB.L/ YEAR NSTALLE450 TYPE Oo .c Y) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chmkae mt qty) L`-1/ SPILL CONTAINMENT ❑ i ALARM FILL TUBE SHUT OFF VAL` RQ 2DROPTUBE ❑ 2BALL ❑ 4EXEMPT ❑ 3STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A a�iplinnormemonboshgps�.nswn x simmiueem Iactwl egmsY7 IF SINGLE WALL TANK(�all wtappy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 I VISUAL(EMSED PORTION ONLY) (arck�ttao only) ❑ ❑ SMANUAL TANK GAUGING ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STA71SUCAL NVENTORY RECONCU IATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING 990THF32 E]3 MANUAL MONITORING ❑ V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MOMAY) 455 ASTUTATED QUANTITY OF SUBSTANCE REMAINING 456 1 TANK FILLED WITH VERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)