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wwPROGRAM CONSOLIDATED FORM go TANK: TA0506490 PR#: PRO506488 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0007458 (two pages per tank) Page 4 of / TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (chxk aey nca oNy) - ❑ 7 PERMANENTLY CLOSED ON SITE (SPc [3 rmson-for lural use oNyl (SPairyrasou-forlowl use only) 3 RENEWAL PERMIT ❑ BTANK REMOVED BUSINESS NAME(snneu FAaurYNAME aDIM-Doingaminen M) FACILITY ID: PR#: O I�3ISL 7-ELEVEN' #32190A 3 FA0007458 PRO506488 LOCATION WITHIN SITE(opun i) 4943 S HWY 99,STOCKTON 8 431 l PHONE u �1 I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subrnitted W the local agency.) TANK m# Tank#: 2 432TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0506490 TOTAL CONTAINMENT lfw.",a nmplaceMPagermeaeh�amnmk DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1/1997 10,000 I ADDITIONAL DESCRIPTION(Formal me muy) 438 D.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Vmmkwimmpkte Petmkmn Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL - ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ IL.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(win Rvardoirs M,wi.6Immmry page) 441 CAS#(eau H.ar .M.un.k[..,Page) 442 ❑4.HAZARDOUS WASTE (1.1 ®uadoil) ❑95.UNKNOWN IH.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cbxlram imn ony) EXTERIORMEMBRANELINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIA.-primary taok ❑ 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 4a (Check mc am mdy) ❑ 2.STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ I.HARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (ab kone item only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/I001.METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL 99.OTHER !T` _ ❑ 5.CONCRETE N`i`6- TANK INTERIOR LINING ❑ L RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 441 OR COATING (Cha ftcrn a8y) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Fwl ul uwonly) OTHERCORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC [-] 95 UNKNOWN 648 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 4IMPRESSED CURRENT [j99OTHER (Chvk mic itan°"y) ❑ 2SACRIFICIAL ANODE (Fabml me mty) SPILL AND OVERFI YEAR INSTALLE450 TYPERmlmcady) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chak all Net appy) I SPILL CONTAINMENT 1,9097.4 a�,S 1ALARM I�❑ 3 FILL TUBE SHUT OFF VAL' 2 DROP TUBE C `�i 2 BALL y y� E] 4 EXEMPT 3 STRIKER PLATE 6 FLOAT IV.TANK LEAK DETECTION(A dcnuamd monaaingpmgrnndlun be sa.hW m Ne lad agency) IF SINGLE WALL TANK(Chakall wtappy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Ch k4 nmi a8y) ❑ 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 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(YWMO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑No UPCF(12/99 revised)