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iN.. ED PROGRAM CONSOLIDATED Ft 'A TANKS r- UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) TYPE TIO ❑1 NEW SITE PERMIT PUREage _ N� ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check Wfh4m only) ❑ 7 PERMANENTLY CLOSED ON SITE -,j l- ( ❑ 3 RENEWAL PERMIT (Speedy reason-far local use only) (Specfy realm-tor local use ocy) ❑ 6 TANK REMOVED 430 BUSINt9S:NAMG'(*me as FACILITY NAME or DBA-Doing Business As) 3 1 FACILITY ID: 1 1 7-Eley' #33 0 LOCATf,ON WI kIM SITE(optional) 431 49435. StateRooute 99, Stockton, CA I TAt (OfiSCRIPTION (A scaled plot plan with the location of the USTSystem including buildings and landmarks shall be submitted to the local _ - a enc.) TANK ID# 4"? TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 3 Xerxes If'Yes',complete one page tar each comp.mosm. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 6/2003 10,000 ADDITIONAL DESCRIPTION(Far oral usa onty) 438 -,117-T, _CONTENTS - - TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (R marked complete Petroleum Type) ®16. PREMIUM UNLEADED ❑3. DIESEL [16. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Gasoline (Includes Used 011) ❑95.UNKNOWN CTIO'c- .. ,.. ..,. ,,... - e- TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 02. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL-primary tank 01. BARE STEEL ❑3. FIBERGLASS/PLASTIC [15. CONCRETE ❑95. UNKNOWN 444 (Check arts,Rem only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS 19 8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATER IAL-secondary tank 01. BARE STEEL 03. FIBERGLASS/PLASTIC 05. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ®B. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑S.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYO LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Check one than only) (For tocol use achy) OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check me Ilam only) ❑2 SACRIFICIAL ANODE - (Far local...NY) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(Ioral use ally) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ®1 SPILL CONTAINMENT that apply) 2003 ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 ®2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 2003 IV.TANK LEAK DETECTION(A description of the niondoriig program shay he submilied m the local a9ency.) IF SINGL[WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH-BLADDER 454 (Check one item only) ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV:TANK-CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE - ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 4'1 REMAINING - gallons ❑Yes ❑ No UPCF(1199 revised) Formerly SWRCB Form B