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FIED PROGRAM CONSOLIDATED FORM I ( TANK: TA0144602 I PR#: PR0231446 UNDERGROUND STORAGE TANKS - TAN FAC#: FA0000853 ( (two pages Pag TYPEOFACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6TEMPORARYSITEC OSURfCI (Cberk oNyb�OnH) `S: ' "s ❑ 7PERMANENTLV EDO I_.u1e ISpadfy.amn-fmkcalwewy) (Spm „6ck 1nseonly3 ❑ 3 RENEWAL PERMIT STANK REMOVED o - El BUSINESS NAME(Same as FACILITY NAME m DBA-Doing Rwinns AS) FA('ILI II ID: PRI;: 1 DOCTORS HOSPITAL OF MANTECA FA0000853 PR0231446 LOCATION WITHIN SITE(Oprimup 1205 E NORTH ST,MANTECA 431 PHONE 1.TANK DESCRIPTION(A scaled plat plan with the location of the UST system including buildings and lasMmarks shall be submitted to the local agency.) TANK ID# Tank#: 2 432 TANK MAWAC_TURRER 4p I COMPARTMENTALIZED TANK E:1 Yes El No 434 TA0144602 10VJfrk cor NI If Na'.compine onepa8c fw®ch rn�annunt DATE INSTALLED(YEAR/MO) 435 TANK CAPACEIY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 550 ADDITIONAL DESCRIPTION(Fo.1.1 meomy) 439 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE dao M I.MOTOR VEHICLE FUEL ❑ is.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmukadc ieef`w] nTypc) ❑ lb.PREMIUM UNLEADED ®3.DIESEL ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑ 4.GASOHOL [:199.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(r Haa.doua mucoab lmmwypage) 441 CAS#(t HoaNas page) 442 ❑4.HAZARDOUS WASTE (Iveludo Used Oil) ❑95.UNKNOWN HL TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CMck on<ken 0*) EXTERIOR MEMBRANE LINER [195.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 (Clickn item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99 OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL K3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (CM1ak one imm only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FTBERGLASS ❑ s.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Omckoncita Wy) ❑ 2ALKYD LINING ❑4PHENOLIC LINING El6UNLINED ❑ 99.OTHER (Fmtmlmcmly) OTHERCORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED m9 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT E:199OTHER (Ch .imnmJ y) ❑ 2SACRIFICIAL ANODE (Far lanl me ovH) SPILLANDOVERFILL YEAR INSTALLE450 TYPE(I Iwccoly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Camkall Nat apply) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL` ❑ 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT N.TANK LEAK DETECTION(Adescription ofde=nimrizgpm9runsull beaubmiaMm 9K bal 29 ) IF SINGLE WALL TANK(CMkall lheappH) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (CMck arc hen 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 ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DA LAST ED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 459 }� ❑Yes ❑ No UPCF(12/99 revised)