COMPLIANCE INFO_1997-2003 - Laserfiche WebLink

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A111111, AIIIIIII, IKVM PROGRAM CONSOLIDATED F( VI TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 s w (two pages per tank) p�cctt-_�� S Pap-of- TYPE 11t-✓_ION n'❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 8 TEMPORARY SITE CLOSURE (Check cy�m only).7 ❑ 7 PERMANENTLY CLOSED ON SITE M 1 ❑ 3 RENEWAL PERMIT (Specify reason-far localuse only) (Specify reason-forlorn use only) ❑ B TANK REMOVED 430 BUSINESS.NAME jtgne as FACILITY NAME or DBA-Doing Business As) FACILITY ID: 7 7-Eleven#32 0 3 LOCATION WIT , SITE(Opuona0 431 4943 S. State Rooute 99, Stockton, CA 1.TANK DESCRIPTION -(A scaled plot plan with the;location of the UST.system including buildings and landmarks shall be submitted to thelocal _ agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 1 Xerxes If'Yes,complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 438 NUMBER OF COMPARTMENTS 437 6/2003 15,000 ADDITIONAL DESCRIPTION(For local use only) 430 ,,%' ; � II.TANK CONTENTS i TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (If marked complete Petroleum Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL ❑S. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Minerals Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Gasoline (Includes Used Oig ❑95.UNKNOWN III. TANK CONSTRUCTION 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 ®1. BARE STEEL [13. FIBERGLASS/PLASTIC [15. CONCRETE ❑95. UNKNOWN 444 (Check ore,item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ®8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-s ndaqunk 01. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE 095. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ®8. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE [110.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED [:13.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑8 UNLINED [:199 OTHER (Check one item only) (For 1ora1 use only) 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 one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EOUIPMENT: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 ofthe monitoring program shall he submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑i VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑e VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑STANK TESTING +(SIR) BIENNIAL TANK TESTING 0 9 OTHER - IV.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIIM ATED NING QUANTITY OF SUBSTANCE 458 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B