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IED PROGRAM CONSOLIDATED FOR19 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 9 9 O (two pages per tank) Page_of_ TYPE OF ACTION ❑i NEW SITE PERMIT ❑ 4 AMENDED PERMIT N 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Sperry reason-forlwal use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 II1 BUSINESS NAME(Sema as FACILITY NAME or DBA-Doing Business As) 3 FACLITY I I 7-Eleven#32190 F 431 LOCATION WITHIN SITE(Optional) 4943 S. State Route 99, Stockton, CA I.TANK DESCRIPTION (A scaled plot plan with the location c.:.he UST system including buildings and landmarks shall be submitted to the local age . TAN KI # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes El NO 434 p5�s GXerxes If"Yes',complete one page for each compartment DATE INSTALLED(YEA O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 6/2003 10,000 ADDITIONAL DESCRIPTION(For local use only) 438 It.TANK CONTENTS- TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑2. LEADED C15. JET FUEL (8 marked complete Petroleum Type) [I 1b. PREMIUM UNLEADED ❑3. DIESEL 06. AVIATION FUEL ❑2. NON-FUEL PETROLEUM N tc. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (tram Hazardous Materiels Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Gasoline (Incudes Used Oil) ❑95.UNKNOWN III: TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check ane item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN N 2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT [199. OTHER - rimary lank 1. BARE STEEL ❑3. FIBERGLASS/PLASTIC 5. CONCRETE ❑95. UNKNOWN 444 TANK MATERIAL p (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS N 8. FRP COMPATIBLE W/ [199.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secandaytank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE [195. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS N S. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL [IS. CONCRETE [110.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 448 DATEINSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (For 1=1 use only) (Check ane item only) 448 DATEINSTALLED 449 OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all N 1 SPILL CONTAINMENT 2003 ❑1 ALARM N 3 FILL TUBE SHUT OFF VALVE that apply) N 2 DROP TUBE 2003 ❑2 BALL FLOAT ❑4 EXEMPT N 3 STRIKER PLATE 2003 IV.TANK'LEAK DETECTION(A description ofthe monHotlngprogiam shell be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE N 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING El 99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENTS.CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE 458 0 457 ESTIMATED DATE LAST USED(YR/MO/DAY) REMAINING TANK FILLED WITH INERT MATERIAL. gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B