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IED PROGRAM CONSOLIDATED FORM TANK: TA0507935 PR#: PRO231073 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC M FA0002064 (two pages per tank) TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION 6 Page 4 of 5 1 (Clerk only iron only) ❑ TEMPORARY SITE CLOSURE 11'-IfIP6L (Sp r5 twsmt r lmel,uc°nbl '-' E] I PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT (spa rewaon-t tact ❑STANK REMOVED p 436 BUSINESS NAME(Sanwa:FACILInNA EcroBA-o°ineea,m::I FACILITY ID: PR#: 7 ELEVEN STORE#14117 D/2237 FA0002064 PR0231073 LOCATION WITI"N SITE(OpmwO 2725 COUNTRY CLUB BLVD,STOCKTON 31 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the kcafion of Ore UST system including buildings and 1,ntirks stall be submitted to the local agency.) t,.f4i1/J TANK ID# Tank#: 5 432 TANK MANUFACTURER .1 COMPARTMENTALIZED TANK TA0507935 ❑Yes ❑No 434 TOTAL CONTAINMENT rrn^,mwpkwmwp ae rmwcnm w mmmt. DATE INSTALLED(16/1/90) 425 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 4/16/1998 10,000 °J (�(% ADDITIONAL DESCRIPTION(For low[me may) 439 D.TANK CONTENTS TANK USE 039 PETROLEUM TYPE ® I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑2.LEADED ❑ Soa Ormahed rmroRta Fewlcwn Tyye) .JET FUEL ® Ib.PREMIUM UNLEADED ❑3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED E] 3.CHEMICAL PRODUCT E]4.GASOHOL ❑99.OTHER COMMON NAME((mm xaaard°m matmiam lmmtmy vase) 441 CAS#(6mn xawmotn matmiah im-mtny page) 442 E]4.HAZARDOUS WASTE (Includes UZW Oil) F-195.UNKNOWN DI.TANK CONSTRUCTION TYPEOFTANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM al (Clmk mwitwn otdy) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑99.OTHER TANK MATERIAL-ptin�ary tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 444 (Chat cm item only) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.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 (n'�eonc i1cin an1y> ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ B.FRPCOMPTIBLEW/100%r METHANOL REINFORCED PLASTIC(FRP) El to.COATED STEEL L)8 99.OTHER ❑ 5.CONCRETE T _TA1"\s� :3-We4 TANK INTERIOR LINING ElOR COATING 1.RUBBER LINED E]3.EPDXY LINING ❑ 5.GLASS LININGE]95.UNKNOWN 446 DATE INSTALLED b2 (Chvk me i.amy) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑99.OTHER (Fml°wl..nly) OTHER CORROSION ® I MANUFACTURING CATHODIC 449 PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED (Chmkaneitemonly) ❑4 IMPRESSED CURRENT ❑ 99 OTHER ❑2 SACRIFICIAL ANODE (Pmlowl me mdy) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(awl me only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (CI tall that apply) I SPILL CONTAINMENT 1,998.081 f4 2 DROP TUBE _Igy 8 PbALARM I ` ❑ 3 FILL TUBE SHUT OFF VAL' 2 BALL ❑4 EXEMPT 3 STRIKER PLATE 9 FLOAT IV.TANK LEAK DETECTION(A d.r*ion°ftl� rmimringpmm.m tWlu.:�mdto tk l°ra1 aamry.> IF SINGLE WALL TANK(Clwrk all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (aecA°"c't'n only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL M VAULT ONLY) ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY 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 P ❑Yes ❑No UPCF(12/99 revised)