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PROGRAM CONSOLIDATED FORM 4PW TANK: TA0506491 PR#: PRO506488 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0007458 (two pages per tank) Page 6 of TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Clwk oNy ilan only) ❑ ]PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT ❑8 TANK REMOVED 43 BUSINESS NAME(semess FAcn.ITY NME or DBA-mine 9mmw As) FACILITY ID: PR#: I ,71 7-ELEVEN* #32190A 3 FA0007458 PR0506488 TTT LOCATION WITHIN SITE(optimo0 4943 S HWY 99,STOCKTON 431 PHONE D I 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.) TANKIDN Tank#: 3 432TANK MANUFACTURER 433 COMPARTMENTALIZED TANK El Yes El No 434 TA0506491 TOTAL CONTAINMENT If"Yn",coup)..1.1 fmwrheompamnem. 5�'a DATE INSTAI,I.ED(YEAR/MO) 435 TANK CAPACITY INGALIANS 436 NUMBER OF COMPARTMENTS 437 4/1/1997 15,000 i ADDITIONAL DESCRIPTION(P«Iwl me only) 439 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (ifmatkW wople¢Petrokmn Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMIHAZARDAL OUS ODUCTWASTE COMMON NAME(sue,Haavdom sueeials lmemmy Page) 441 CAS#(6om Hseuivas Malwis lnvmmry page) 442 ❑4.HAZARDOUS WASTE (Imlude Used Oil) ❑95.UNKNOWN IO.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cheek ow item only) 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 (Chdorcitan aNy) ❑2.STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE [-195.UNKNOWN 445 (Cleek mrI=only) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%a METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL 4/L.a74J 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED M7 OR COATING (C ove item only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ® 6 UNLINED ❑99.OTHER (Pm lural use avly) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED up PROTECTION IF APPLICABLE PROTECTION (Check om item only) El IMPRESSED CURRENT El 99 OTHER ❑ 2SACRIFICIAL ANODE (Fm loin ire mdY) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(bwlmeady) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chrkallthtapply) I SPILL CONTAINMENT 1,997.00 (ALARM o 4 L ❑3 FILL TUBE SHUTOFF VAL` 2 DROP TUBE q 9 2 BALL ❑4 EXEMPT 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A description otthmonitminapro&amahll be sulemined to the .sorer.) IF SINGLE WALL TANK(Clavk all slut apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (mak one nem only) ❑ 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(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING456 TANK FILLED WITH INERT MATERIALQUANTITY ❑Yes ❑No UPCF(12/99 revised)