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IFTED PROGRAM CONSOLIDATED FORMIlk2 Q� TANK: TA0505871 PR #: PR0505867 UNDERGROUND STORAGE TANKS - TAN E 1 FAC #: FA0007059 a`{ 03 (two pages per tank) Pa8c 8 af9 TYPEOFACTION ❑ INEW SITE PERMIT ❑ 4AMENDEDPERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (G Goly'ilmna y) ❑ ]PERMANENTLY CLOSED ON SITE 1�I t rtaw rcrl em l)j S Fj rayon f rla:�l mem lyl. ❑ 3RENEWAL PERMIT !. ❑STANK REMOVED 430 BUSINESSNAME(9 UFACR NAM DBA -Doug Buslmzs>ei 1A(II11} 11)- PIt2: 1 TOWER MART #104 FA0007059 PR0505867 LOCATION WITHIN SITE (oPlica o 192 LATHROP RD, LATHROP 431 PHONE I. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be subnu ted to the local agency.) TANK ID# Owners Tank ID#: 104-D 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ❑ No 434 4 TA0505871 MODERN WELDING R'Yn".dargknozpagcf aM oonqunrnt. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 6/15/1998 I 12,000 ADDITIONAL DESCRIPTION (Fm lad rn4 mty) 439 H. TANK CONTENTS TANK USE 439 PETROLEUM TYPE Mo ® 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (Ifm,ked Ide Peaoldon Type) ❑ Ib.PREMIUMUNLEADED ® 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ Ic. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME(6omxa:udom Materiels lnvrno PW) M1 CAS#(f HamNPn Mam+Wlnvntmypage) 442 ❑ 4. HAZARDOUS WASTE (mama wee a0 ❑ 95. UNKNOWN M. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM M3 (LTdk mcimn Wy) EXTERIORMEMBRANE LINER ❑ 95. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER TANKMATERW.-prlmarytank ❑ I. BARE STEEL ❑ FIBERGLASS/ PLASTIC ❑ S. CONCRETE ❑ 95. UNKNOWN 444 (Oah meilvnmly) ❑ 2. STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ® a. FRP COMPTIBLE W/ 100% METHANOL REINFORCED PLASTIC (FRP) ❑ 99. OTHER: TANK MATERIAL - secondary tank ❑ I. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95, UNKNOWN 445 (cl9:kmcimnmy) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS "�B. FRP COMPTIBLE Wit 00%METHANOL REINFORCED PLASTIC (FRP) cLfJ-10. COATED STEEL ❑ 99. OTHER ❑ 5. CONCRETE TANK INTERIOR LININGE]L RUBBER LINED ❑ 3. EPDXY LINING E]5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 4a OR COATING ❑ 99. OTHER (L'h k itanmy) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED (Porlmlidemy) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN Me DATE INSTALLED M9 PROTECTION IF APPLICABLE PROTECTION ❑ 41MPRESSEDCURRENT E]99 OTHER (Lt to am imn 0*)F1 2 SACRIFICIAL ANODE (Fa local uu mty) SPIV AND OVERFILL ' YEAR INST-A�LLLE4550 TYPE(enl **) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 4$2 (CM�k aU mu m yF". ) 1 SPILL CONTAINMENT Gw3 Qf " C]I ALARM D(3 FILL TUBE SHUT OFF VAL' C'� �1;9/9�&90• VC2 DROP TUBE zma ❑ 2 BALL ❑ 4 EXEMPT ❑ 3STRIKER PLATE FLOAT IV. TANK LEAK DETECTION (A dsmpom utdwmmdtmm9Po9nnabatl4e.m"nm to a. 1e1.,9mcy.) IF SINGLE WALL TANK (C ill Nv apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL (EXPOSED PORTION ONLY). ❑ 5 MANUAL TANK GAUGING (MTG) (O"H`One nanmty) ❑ 2AUTOMATIC TANK GAUGING (AID) ❑ bVADOSE ZONE ❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 3CONTIN000S ATG ❑ ]GROUNDWATER ® 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORYRECONCILIATION ❑ 8TANK TESTING ❑ 3 MANUAL MONITORING (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER V. TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTUSATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 45r 6/15/1998 0.00 gallons ❑ Yea ❑ N0 UPCF (12/99 revised) RIF