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Ly lailDiDr IFIED PROGRAM CONSOLIDATED FO I 1%W *al/ jzh9 OZ0(t�' TANKS UNDERGROUND STORAGE TANKS TANK PAGE 1 pages per tank) Page 5 of 6 TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Checkooewrnonly) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RFNEWALPERMIT (speciryrcason-fortmalmeonly) (Spedrymoom-f«loaalmemly) ❑ 8 TANK REMOVED 430 BUSINESS NAME same as FACILITY NAME«DBA-Doing Business As) 3 FACILITY ID: 0 0 0 0 0 0 0 0 0 0 0 Chevron Station#98264 11 1 1 1 LOCATION WITHIN SITE(optimal) �/S 431 3775 Trac Blvd.,Tracy,CA 95376 Y( I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TAyN(K ID# 432 TANK MANUFACTURER 033 COMPARTMENTALIZED TANK Yes No 434 4f 1 '� D �� XERXES IVYei',complete ons page for each component. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 036 NUMBER OF COMPARTMENTS an 1/1/96 15000 0 ADDITIONAL DESCRIPTION(For local we only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 j ®1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (Ifnarked campine Petmkum Type) ®Ib. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION FUEL , ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (6om H.erdons Mmemis Invem«y page) MI CAS#(6om Heomt. s Matenals Invemory page) 442 ❑4. HAZARDOUS WASTE (Imind®Uaea oil) PREMIUM UNLEADED 800-61-9 ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑L SINGLE WALL ❑3. SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one nem only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL [14. SINGLE WALL IN VAULT [199. OTHER_ ! TANK MATERIAL-Primary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC 05. CONCRETE 095. UNKNOWN 444 (Chink one nem only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank ❑1. BARE STEEL 03. FIBERGLASS/PLASTIC El 5. CONCRETE 095. UNKNOWN 445 (Check one new only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) [110.COATED STEEL ❑5. CONCRETE 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 N 6 UNLINED ❑99 OTHER (Chink one hem only) (For kraal ase only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN Mo ma PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER (Check one nem only) ❑2 SACRIFICIAL ANODE (Fm local--only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all thin apply) ®1 SPILL CONTAINMENT ®3 FILL TUBE SHUT OFF VALVE 1995 ®1 ALARM OPW 61-SO4 ®2 DROP TUBE 1998 OP W 61-SO-4 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE Tank Mfg _ IV.TANK LEAK DETECTION(A description ofthe monitoring program span he suhmnted to the local agency.) IF SINGLE WALL TANK(check el0ut appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 464 (Check ora 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/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No ` UPCF(1/99 revised) 177 Formerly SWRCB Form F