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IED PROGRAM CONSOLIDATED FORM TANK: TA0507934 PR#: PR0231073 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0002064 (two pages per rank) TYPE OF ACTION Page 2 of5 ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chat aNY item ody) ( (Spaify«ason tm local rec oW.) ❑ 7 PERMANENTLY CLOSED ON SITE N. (Spatb rmm�-[doral nscanl �SRENEWAL PERMIT )) ❑ STANK REMOVED 430 BUSINESS NAME(Samem FACILITY NAMB mDBA-_1 "Bndnas As) FACII,ITY ID: PR#; D 7 ELEVEN STORE#14117 D/2237 FA0002064 PR0231073 LOCATION WITIIIN STE I (opuow) 2725 COUNTRY CLUB BLVD,STOCKTON F)SI BN 4n W PHONE J I I.TANK DESCRIPTION(A scaled plot plan with the location E the UST system including buildmgs and landmarks shall be submitted to the local agency.) TANK ID# Tenk#: 4 011 TANK MANUFACTURER 633 COMPARTMENTALIZED TANK (Cr•AT/ TA0507934 ❑Yes ❑NO 434 TOTAL CONTAINMENT v ^,wmpin prcpagerm d wmpam al. �� DATE INSTALLED(YEAR/MO) 035 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 5I� 43] 4/16/1998 10.000 ADDITIONAL DESCRll'TION(For loeal meomy) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE IN I.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑2.LEADEDu0 ❑5.JET FUEL ptmarkedmmplemPmolcwi Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Jr.MIDGRADE UNLEADED ❑ 3.CHEMICAL PRODUCT ❑ 4.GASOHOL ❑ 99.OTHER COMMON NAME(r Haardous Maarisb ❑4.HAZARDOUS WASTE InvMorypage) 961 CAS#(eom x.r niew Matenem Inventory page) 442 pnclW wea oil) ❑ 95.UNKNOWN BI.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chat one Tum only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERW--primary lank ® I.BARE STEEL ❑ FIBERGLASS/PLASTIC - S.CONCRETE ❑ 95.UNKNOWN 444 (Cherk p item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary lank ❑ 1.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN 445 (ClmJ,a nen only) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100I9�j METHANOL REINFORCED PLASTIC(FRP) El 10.COATED STEEL `/-`99.OTHER ,I ❑ 5.CONCRETE NAZ K S TANK INTERIOR LINING 1.RUBBER LINED ❑ 5.GLASS LINING OR COATING ❑ ❑ 3.EPDXY LIMING 95.UNKNOWN 446 DATE INSTALLED "] (Chakone Ilan only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Fmlaalmeany) OTHER CORROSION ® 1 MANUFACTURING CATHODIC449 PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED (Chat ma imnonly) ❑4 IMPRESSED CURRENT ❑99 OTHER ❑ 25ACRIFICIAL ANODE (Fa local use only) SPILL AND OVERFILL YEAR INSTALLE45u TYPE0I me only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chakallam I SPILL CONTAINMENT aoPty> 1.998.00 �j 1 ALARM 1�4% 1I El3 FILL TUBE SHUT OFF VAL1 2 DROP TUBE 111% 33TKERPLATE 1156 FLOATIRI IV. RI IV.TANK LEAK DETECTION(w avaipnonorsne momimo,gpm�m,slun Irc aubmiod,o u8:l��al4gelley.) IF SINGLE WALL TANK(Cnecka110m eppty) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 El VISUAL(EXPOSED PORTION ONLY) El MANUAL TANK GAUGING(MTG) (Chat one nem only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL FNVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑ 99 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) L