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IFIED PROGRAM CONSOLIDATED FOR TANK: TA0505870 03 PR #: PR0505867 FAC #: FA0007059 UNDERGROUND STORAGE TANKS - TAN GNNJJ p P� D (two pages per tank) Page 6 of 9 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (L oolyiosnonly) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT ❑ 8 TANK REMOVED 430 BUSINESS NAME Ismneas FACILITY NAME orDRA- Doing Bivia«.s M) FACILITY ID: PR#: 1 TOWER MART #104 3 FA0007059 PR0505867 LOCATION WITHIN SITE (Optional) 192 LATHROP RD, LATHROP 431 PHONE 1. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be subnnaed 0 the local agency.) TANK ID# Owners Tank ID#: 104-P 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑ No 434 3 TA0505870 MODERN WELDING rrY«^. ®aPhtc«se Pag<r«�noonP.�m..n. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 07 6/15/1998 20,000 ADDITIONAL DESCRIPTION (F«lo«1 use wy) 438 IL TANK CONTENTS TANK USE 43a PETROLEUM TYPE 4ao ® 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (IfmarkMmrylnc Pc�mMvn Tyye) ® I b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2.NON4UEI-PETROLEUM ❑ le.MIDGRADEUNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (fi«nllmrdwv MatwiJa Imosos, gc) q41 CAS# (frvn Hamtdmo mawi.ts ss, a page) 442 ❑ 4. HAZARDOUS WASTE (Mato&« wmai) ❑ 95. UNKNOWN HI. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑ 3.SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Ct«k i. only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL -prirrery tank ❑ I. BARE STEEL ❑ FIBERGLASS/ PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Ch ooe iremwly) ❑ 2. STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ® 8. FRP COMPTIBLE W/ 100% METHANOL REINFORCED PLASTIC (FRP) ❑ 99 OTHER TANK MATERIAL - secondary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 445 (Clc&oncmooNy) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS S. FRP COMPTIBLE W/100% METHANOL REINFORCED PLASTIC (FRP) 10. COATED STEEL ❑ 99. OTHER: ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 417 OR COATING (Cberkaneimnony) ❑ 2ALKYD LINING ❑ 4PHENOLIC LINING ® 6UNLINED ❑ 99. OTHER (F«Mael use any) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATENSTAL-LED "a PROTECTION IF APPLICABLE PROTECTION 4 IMPRESSED CURRENT ❑ 99 OTHER (Ch .itonwy)❑ kd ❑ 2 SACRIFICIAL ANODE (P« we Wy) SPILL AND OVERFILL YEAR MSTALLE450 TYPE(la«I wcmty1 451 aW) OVERFILL PROTECTION EQUIPMEN]': YEARINSTALLED 452 (Klt AtosWPty) Xp� ISPILLCONTAINMENT }r¢R$,QQ ,} L,JC ❑ (ALARM IcVN3FILLTUBESHUTOFFVALrppI,J-6 K5l 2 DROP TUBE 20co- ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV. TANK LEAK DETECTION (A daafpdoo ofu moot«me pmt4amsbanbe smnvt 00w loot IF SINGLE WALL TANK(Cb«ka0 dso appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (MTG) ICLeckamrr�«SY) ❑ 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 (YR/MOMAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINNG 456 TANK FILLED WITH INERT MATERIAL? 457 6/15/1998 0.00 gallons ❑ Yes ❑ No UPCF (12/99 revised) ISO