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IED PROGRAM CONSOLIDATED FORM 1p TANK: TA0506323 UNDERGROUND STORAGE TANKS -TANK PAGE 1 PR#: PR0231435 FAC#: FA0000916 (two pages per tank) 41) TYPE OF ACTION1 NEW SITE PERMIT age6 of 7 (ankoo]yimnonly) ❑ ❑OAMENDED PERMIT ❑ SCHANGE OF INFORMATION ❑ 6TEMPORARY SITE CLOSURE P ❑ 7 PERMANENTLY CLOSED ON SITE (SP f}reuon fort«al rec oNy). (apm ryryaon f local use onl}. 7 RENEWAL PERMIT y ❑ STANK REMOVED Ir 430 9 BUSINESS NAME(Same a a FACILITY NAME or DBA-Poing Bmims As) FACILITY ID PR#: \ I ��13 7 ELEVEN#19976* J FA0000916 PR0231435 LOCATION WITHIN SITE(o s om0 1399 N MAIN ST,MANTECA 431 PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and la7shallbnuned to the local agency.) 1a"TANKID# Tank#: 6 432 TANK MANUFACTURER 433 COMPAATA0506323 ❑Yes ❑No m4TOTAL CONTAINMENTDATEINSTALLED( EARMO) 435 TANKCAPACITYINNNUMBEMENTS 437 9/20/1996 10.000 ADDITIONAL DESCRIPTION(F«low]we Doty) /QID� 438 I TANK USE 4J9 PETROLEUM TYPE D.TANK CONTENTS 91 1.MOTOR VEHICLE FUEL is.REGULAR UNLEADED ❑ 2.LEADED ❑ S.JET FUEL "a (IfmarkM wmplee Penolenn Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED E]1 CHEMICAL PRODUCT ❑4.GASOHOL ❑ 99.OTHER COMMON NAME(uom xawraone Meeia]a mvmwrypaBe) 441 CAS#(6qn Haaamow Mawnab w.smory Page) ❑ 4.HAZARDOUS WASTE g42 Rne]adq uaed a9 PREMIUM UNLEADED ❑ 95.UNKNOWN ID.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CM one it=only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-Primary tank ® L BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (C k one nen oNy) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑".OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Chek.itamonly) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL N 99.OTHER.r ❑ 5.CONCRETE TANK INTERIOR LINING OR COATING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN w6 DATE INSTALLED a7 (Click one imn only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ®6 UNLINED ❑99.OTHER (For]=I ins only) OTHERCORROSION ® I MANUFACTURING CATHODIC PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 (C onelumody) ❑ 2 SACRIFICIAL ANODE ❑ 4 IMPRESSED CURRENT ❑99 OTHER FF-local pupldy) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(IcaI.-ly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Click all Nat apply) I SPILL CONTAINMENT 1,996.00 �a 2 DROP TUBE 19g� I ALARM S.L❑ 3 FILL TUBE SHUT OFF VALr 2BALI, 1QGL ❑4EXEMPT \99� 35TRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A awr<iplim of no nnomwrigpre®am aweb s,,,o,nM toN,won]awry.) IF SINGLE WALL TANK(C k al]Nal apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Crook one i.only) ❑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 ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑"OTHER ❑3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑No UPCF(12/99 revised)