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'IED PROGRAM CONSOLIDATED FORM TANK: TA0k431 PR#: PR0 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA (two pages per t Page TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Cbwk only iwa only) ❑ 7 PERMANENTLY CLOSED SIT ISp b n for local roc oma (Spcnrymaaon for foal usa only) ❑ STANK REMOVED 3 RENEWAL PERMIT BUSINESSNAME(s..FACILGYNAMEm DBA-Dotn,Bminws As) FACILITY ID: PH#: Q 7 ELEVEN#17647 B/2237 FA0000508 PR0231462 U LOCATION WITHIN SITE(opdmnl) 1048 W YOSEMITE AVE,MANTECA pro,PHONE Jr{�3/II V 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.) s� TANK ID# Tank#: 5 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK (3Yes E]No 434 TA0507949 TOTALCONTAINMENT Ir•Ya•.<amPlamaa.va,•rar.,maampamaam� DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 5/1/1998 10,0 0 ADDITIONAL DESCRIPTION(Fm local recooy) 431 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ® Ia.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmahedcomplmpmmlman Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(ft.Hamrdwe MmanaLslmnlmypagc) 441 CAS#(6mn xaudaos M.urwls lmwtory page) 442 ❑ 4.HAZARDOUS WASTE (I.Id Uwon) ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check mm I=ooy) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Caokmm(tmoomy) ❑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 (Check ane itmn only) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD WNIBERGL.ASS ❑ S.FRP COMPTIBLE W/10000%a METHANOL REINFORCED PLASTIC(FRP) [jHI COATED STEEL IYI.99.OTHER / ❑ 5.CONCRETE JiNoI\. TANK INTERIOR LINING ❑ 1.RUBBER LINED E] 3.EPDXY LINING E-] 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ( ckowitemmty) E]2ALKYD LIMING E] 4PHENOLIC LINING ® 6UNLINED E] 99.OTHER C Fwlawlwe ( ovy) OTHER CORROSION ® 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN "a DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 41MPRESSED CURRENT ❑"OTHER (Check ane item only) ❑ 2SACRIFICIAL ANODE (Fm bwluuanry) SPILL AND OVERFIL YEAR INSTALLE450 TYPE(ladmeomy) 451 5��4O,,,,...aaa4VERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (C6eckall tat apply) I SPILL CONTAINMENT 1,998.00 (ALARM ❑ 3 FILL TUBE SHUT OFF VAL` 2 DROP TUBE 2 BALL ❑ 4 EXEMPT 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d crigoo offset ftcringpml m fall be submind to da:1ar1agemy.) IF SINGLE WALL TANK(C kall tat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (CTcck anb) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL NVENTORY 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 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 5/1/1998 0.00 gallons EI-Yes E]No UPCF(12/99 revised)