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IED PROGRAM CONSOLIDATED FORM TANK: TA0507993 0PR#: PR0231233 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0002479 (two pages per tank) TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATIONPage 2 of 5 ❑ 6TEMPORARY SITE CLOSURE (Chark only itmwnly) ❑ 7 PERMANENTLY CLOSED ON SITE e/ I 3RENEWAL PERMIT ❑8TANK REMOVED 430 D(\ BUSINESS NAME($ m FACILITY NAME.,DBA-Doing Bm6mss As) FACMJTYID: PR#: l 7 ELEVEN#17334 D/2237 FA0002479 PR0231233 b) LOCATION WITHIN SITE(opdom0 4501 N PERSHING AVE,STOCKTON 43l PHONE L TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK IDN Tank#: 4 g,2 TANK MANUFACME TURER 413 COMPARTNTALIZED TANK El Yes El N. 434 h� TA0507993 TOTAL CONTAINMENT If'Y., aMlvammpagamrnchama.L 'IU DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/3/1998 10,000 ADDITIONAL DESCRIPTION(Fm 1.1 maanry> 438 II H.TANK CONTENTS TANK USE 419 PETROLEUM TYPE 040 ® L MOTOR VEHICLE FUEL ® Is.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmaflo,J�lme Pa6olemn TY ) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(tram Hawdwe Matmiab larmtarypage) ml CAS#(6om Hazardous Maralala lmmmry page) ❑4.HAZARDOUS WASTE 442 (lnclWn UselOin ❑ 95.UNKNOWN RI.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Ch kaneiten mOY) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ® I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Cock ave iron Dory) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.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 (Che itaamly) ❑ 2.STAINLESS STEEL 04.STEEL CLAD W/FIBERGLASS ❑ e.FRP COMPTIBLE W/10Y0,°,(k METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL 17[I 99.OTHER ❑ 5.CONCRETE JJJ"'VVV -tAV J / � "f (/-� TANK INTERIOR LINING El L RUBBER LINED ❑ 3.EPDXY LINING ^a 1[ EI `(fL� H7 OR COATING ❑ 5.GLASS LINING ❑95.UNKNOWN N6 DATE INSTALLED (CM1 k Dornan tidy) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Forkeal meaNy) OTHERCORROSION ® 1 MANUFACTURING CATHODICE] 449 PROTECTION IF APPLICABLE PROTECTION 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 44e DATE INSTALLED (Clan .iaeaaanry) E] 4 IMPRESSED CURRENT El 99 OTHER ❑ 2SACRIFICW.ANODE (Pm local me orgy) SPILL AND OVERFIL YEAR INSTALLE450 TYPE(lawlm..*) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chxk all Jutapply) I SPILL CONTAINMENT 1,998.00 1 ALARM ❑ 3 FILL TUBE SHUT OFF NAL` 2 DROP TUBE 2 BALL 1 ❑ 4 EXEMPT 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(Adesmipdovofthemmdtarmgpmgnm ahallhaubmindto the kalagemyJ IF SINGLE WALL TANK(C kaB doe appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Clank me it=mdY) 2 AUTOMATIC TANK GAUGING ATG ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ (ATG) ❑ 6VADOSE ZONE ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING [:] 99 OTHER E]3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)