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UNIFIED PROGRAM CONSOLIDA'T'ED FOR' � CyA ` (�J1 TANK: TA0184805 JPR#: PR0231848 UNDERUROUND STORAGE TANKS - TANK PAG , � ��b3 FAC#: FA0002052 0.19 (two pages per tank) TYPE OF ACTION ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT Ej 5 CHANGF.OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE Page 2 of 7 (Check only iter only) ❑ 7 PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT (Specify reason-for tical use only) (Specify reason-for kcal use only) ❑g TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: t ST SERVICES 3 FA0002052 PR0231848 LOCATION WITHIN SITE(optiomq 3505 NAVY DR,STOCKTON 431 PHONE L� f 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.) TANK ID# Tank#: 5 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes f d'No 434 TA0184805 A1111A If"Yes",complete one page for each compartment. DATE INSTALLED( EAR/M0) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 N Q 550 ADDITIONAL DESCRIPTION(For local use only) 439 3/06/00 CHNG PE FR 2315 TO 2360 PER MK.LBR II.TANK CONTENTS TANK USE 039 PETROLEUM TYPE 440 ❑ I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL (If marked complete PetrolettmType) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ® 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL Xr 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Haurdous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) ❑4.HAZARDOUS WASTE 44 (Includes Used Oin ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK p I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN ®2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL X FIBERGLASS/PLASTIC ❑5.CONCRETE ❑ 95.UNKNOWN 444 (Check one item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 443 (Check one item only) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING447 OR COATING ❑ 5.GLASS LINING R95.UNKNOWN 446 DATE INSTALLED (Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑6 UNLINED ❑ ".OTHER (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ® 95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Chock one item only) F14 IMPRESSED CURRENT C399 OTHER ❑ 2 SACRIFICIAL ANODE (For Ian1 use Dory) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local tee only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ❑ I SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL' ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency) IF SINGLE WALL TANK(Cbcck all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chock one item 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 REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)