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_JIFIED PROGRAM CONSOLIDATED FORK] NK: TA0506222 %allep� R#: PRO506221 UNDERGROUND STORAGE TANKS;;-WK PAGE 1 F� 1I i FAC#: FA0007287 Sl6q (two pages per lank) Page 2 of 7 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4AML.\DFDPERMIT ,�S CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Caw Y�OnlY) ❑ ]PERMANENTLY CLOSED ON SITE r-1 }RENEW AL PERMIT mfy-- fs (Sp -emty) (Spmfy Mm+m-farmmmco*) STANK REMOVED 430 ❑ BUSINESS NAME(Saamm FACI.IIYNAME«DBA roma amnia:Ae) FACILITY ID: PR 4: FLAG CITY ARCO/SUBWAY FA0007:: PR0506221 LOCATION WITHIN SITE(001 ) 14931 N FLAG CITY BLVD,LODI 431 PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and latldmatks shall be subnutted to the local agency.) TANK[D# Tank#: 1 432 T^)'I 'R7fA nC 433 COMPARTMENTA[,IZED TANK El Yes ❑No 434 TA0506222 � 0 F�6r>*r+�- vYe.mmpmt<oa<pag<f«®<b<emp:mamt. DATE INSTALLED(YEAR/MO) 435 TANKCAPACITYIN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1/1997 12:00:OOAM 20 000 ADDITIONAL DESCRIPTION(F«mol«eo],) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ass ® I.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Irmandm ,[.P.m T,,) ❑ Ib.PREMRIM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic.M[DGRADEUNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME noo H .Nn..mmwi Lrvrnl«y peg<) yyI CAS#nr Huvtlan M«aials Immt« page) N2 ❑4.HAZARDOUS WASTE (I Ic Ue W) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Clack we aeo my) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-pnnmry IWc ❑ 1.BARE STEEL ® FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 414 (ClckMas iwn adrl ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/[00%METHANOL REINFORCED PLASTIC(FRP) ❑ MOTHER TANK MATERIAL-secondary tanic ❑ 1.BARE STEEL >Q 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (CMkca<urnmlY) ❑2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ I0.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (CMk ca<arn my) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑ 99.OTHER (F«Iom useeaa) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 08 DATE INSTALLED 1a9 PROTECTION IF APPLICABLE PROTECTION (CMk arc I. y) ❑ 4 IMPRESSED CURRENT ❑ 990THFR ❑ 2SACRIFICIAL ANODE (F«aw o<anty) SPILL AND OVERFILL YEAR INSTALLE450 TYPEpoolm<W,) 11 OVERFILL PROTECTION EQUIPMENT:YEAR MSTALLED 452 mss,1 SPILL CONTAINMENT `.l¢)92'Dlf 0004(CMicill aw appb) /� ❑ 1 ALARM , )p FILL TUBE SHUT OFF VOL' 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT N.TANK LEAK DETECTION(A am^g�sbaa be.mmluee m mems,¢y.) IF SINGLE WALL TANK(Cla<kilt Wt Wy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER +Sa (Cbwicmui..Iy) E] I VISUAL(EXPOSED PORTION ONLY) C] 5 MANUAL TANK GAUGING(MTG) ❑ I VISUAL(SINGLE WALL M VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 NODOSE ZONE ❑3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑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 456 1 TANK FILLED WITH INERT MATERIAL'! 457 ❑Yes ❑No UPCF(12/99 revised)