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IED PROGRAM CONSOLIDATED FORM TANK: TA0507939 PR#: PR0231074 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0002541 (two pages per tank) Page of TYPE OF ACTION ❑ INEW SITE PERMIT ❑ OAMENDED PERMIT ❑ SCHANGE OF INFORMATION ❑ 6TEMPORARY SITE CLOSURE (CBe`k only it=only) - ❑ 7 PERMANENTLY CLOSED ON SITE (Sidfyr m-for 1=1 ssse my) _ (Speciyv rson fohxttlo¢ oob) 3 RENEWAL PERMIT - ❑ STANK REMOVED s� BUSINESS NAME(samcas FAclurYNAMEm DEA-Dobgeusincss n,i FACILITY ID: PR#: 7 ELEVEN STORE#20632 B/2237 FA0002541 PR0231074 0. I LOCATION WITHIN SITE(Opuomn 4627 DA VINCI DR STOCKTON 431 PHONE D) 1.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 ID# Tank#: 5 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ONO 434 TA0507939 TOTAL CONTAINMENT If-Y4s'.amryletenrupagefinexbmmpamnem s2 DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 '4V 4/29/1998 10,000 ADDITIONAL DESCRIPTION n orlocal me o*) 431 1"11G/ TANK USE 439 PETROLEUM TYPE D.TANK CONTENTS 40p h IM I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (IfraarkN tonPlete Peunlem Tyye) ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(emn HanNous Motelab lmattorypage) 441 CAS#(firm Haoidm Materials lmmiory page) 442 ❑4.HAZARDOUS WASTE (Ircludc Uad DO) ❑ 95.UNKNOWN UL TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cnakoneimnanly) 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 (Chxk one I=only) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/IN%METHANOL REINFORCED PLASTIC(FRP) ❑99 OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (ChukomimnoNy) ❑ 2.STAINLESS STEEL ❑4.STEELCLADW/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100°/.METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL Dd 99.OTUUR l E] 5.CONCRETE Tit�1c JJ�j TANK INTERIOR LINING ❑ L RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Clock oom ilmsomy) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Forlmlmconly) OTHER CORROSION ® 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 441 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (ClotkmeaanoNy) ❑4 IMPRESSED CURRENT ❑ 99 OTHER E] 2SACRIFICIAL ANODE (Pmlml meanly) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(Imlcemy) 451 OVERFILL PROTECTION EQUIPMENT;YEAR INSTALLED 452 (Check att thin ppp apply) I SPILL CONTAINMENT 1,998.w I ALARM ❑ 3 FILL TUBE SHUT OFF VAL` � 2 DROP TUBE 5q`(8 2 BALL ❑ 4 EXEMPT 3 STRIKER PLATE ,q4B FLOAT IV.TANK LEAK DETECTION(A deception ofine mmMoringpro®am snnbesAntittd m tbelool agooy.) IF SINGLE WALL TANK(L7wek all not apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(Mm) (C am itrn city) ❑ 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 INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER 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 4/29/1998 0.00 gallons ❑yes ❑ No UPCF(12/99 revised)