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� <br /> IFIEDPROGRAMCONSOLIDATED IZ h pZ 0(t. <br /> TANKS <br /> UNDERGROUND STORAGE TANKS TANK PAGE 1pages per tank) <br /> Page 3 offs <br /> TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (Spcuifyseason-farlocxluseonly) (Spedfyreascn-for local use only) ❑ 8 TANKREMOVED 430 <br /> I <br /> BUSINESS NAME(S.as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID: O O 0 0 0 0 0 <br /> Chevron Station#98264 <br /> one0 431 <br /> 3775 Trac Blvd.,Tracy,CA 6 <br /> NK t plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) <br /> TANK ID# 432 TANK MANUFACTURER d33 COMPARTMENTALIZED TANK ❑Yes 0 No 434 <br /> 4 b T4 tea)b pg;S JXERXES I If"Yes",complete one page for each compartment. <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 1/1/96 1 12000 0 <br /> ADDITIONAL DESCRIPTION(For tical use only) 438 <br /> II.TANK CONTENTS <br /> TANK USE 039 PETROLEUM TYPE aao <br /> ®1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL <br /> (Ifmahed compltt<Petmkum Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL [3 6. AVIATION FUEL <br /> ❑2. NON-FUEL PETROLEUM ®Ic. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER <br /> 03. CHEMICAL PRODUCTCOMMON NAME (from llnzardaus Materials lnvemory page) 4a1 CA$#(Goat Hazardous Materials Inventory <br /> page) 442 <br /> ❑4. HAZARDOUS WASTE <br /> (Incmneusedoe) MID-GRADE UNLEADED 800-61-9 <br /> ❑95.UNKNOWN <br /> 1 <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Check one nem only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> 02. DOUBLE WALL [14. SINGLE WALL IN VAULT [199. OTHER <br /> TANKMATERIAL-primar,welc ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE 095. UNKNOWN 444 <br /> (Check oat nem only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER_ <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-secondary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 <br /> (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL [199.OTHER <br /> _ <br /> REINFORCED PLASTIC(FRP) [110.COATED STEEL <br /> [15. CONCRETE <br /> TANK INTERIOR LINING 1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER <br /> (Check one nem only) (For IoW was only) <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN sae "a <br /> PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER <br /> (Check enc item only) ❑2 SACRIFICIAL ANODE (For tial uu only) <br /> SPILL AND OVERFILL YEARINSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Check all that apply) ®1 SPILL CONTAINMENT ®3 FILL TUBE SHUT OFF VALVE <br /> 1995 01 ALARM OPW 61-SO-4 <br /> ®2 DROP TUBE 1998 OPW 61-SO-4 ❑2 BALL FLOAT ❑4 EXEMPT <br /> ®3 STRIKER PLATE Tank Mf _ <br /> N.TANK LEAK DETECTION(A dneription ofthe monitoring program shall be,sumnitted to the local <br /> agency) <br /> IF SINGLE WALL TANK(check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> (Check one nem only) <br /> j ❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> j ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> I ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> gallons ❑Yes ❑ No <br /> E, UPCF(1/99 revised) 175 Formerly SWRCB FOrmB <br /> F1 <br />