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WNWIED PROGRAM CONSOLIDATED F 7(twopages TAItank) UNDERGROUND STORAGE TANKS TANK PAGE 1 pe TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT Page 3 of6 (Check one hem only) ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWALPERMIT (Specilyreason-furloalueerty) (S reaon- PecifY for hswl ueonly) ❑ 8 TANK REMOVED Uo BUSINESS NAME(Same u FACILITY NAME or DBA-Doing Business As) Chevron Station#200764 3 FACILITY ID: O O 0 0 0 0 0 0 0 0 0 LOCATION WITHIN SITE(OphonaQ 4747 West Lane,Stockton CA 95210 431 t.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# 4Jz TANK MANUFACTURER 433 .)t oayooj COMPARTMENTALIZED TANK Yes No 434 'l O WENS CORNING If"Yes",complete one page for each companmat. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY M GALLONS m6 9/28/90 NUMBER OF COMPARTMENTS 12,000 417 ADDITIONAL DESCRIPTION (For bat uu only) . 438 1I.TANK CONTENTS TANK USE439 PETROLEUMTYPE 10 1. MOTOR VEHICLE FUEL, ❑la. REGULAR UNLEADED ado (Ifmarked complete Peuoleum Type) ❑2. LEADED ❑5. JET FUEL ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ®lc- MIDGRADE UNLEADED ❑4. GASOHOL ❑3. CHEMICAL PRODUCT ❑99. COMMON NAME (6om Fluardous Materials Invemory CAS#( u ❑4. HAZARDOUS WASTE page) 441 CAS# from Hatdous Materub Inventory page) 443 pmludes Used Oil) MID-GRADE UNLEADED ❑95.UNKNOWN - 800-61-9 III. TANK CONSTRUCTION 7YPEOFTANK ❑1. SINGLE WALL 3. SINGLE WALL WITH S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one hem only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 02. DOUBLE WALL ❑4. SINGLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL_primary tank ❑ I. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 4t (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL ❑99 OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL_aecondvy unk ❑1. BARE STEEL 3. F®ERGLASS/PLASTIC ❑5. CONCRETE 095. UNKNOWN 445 (Check onehem only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED 3.EPDXY LINING ❑5.GLASS LIN 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 6 (Check one item only) ® UNLINED ❑99 OTHER OTHER CORROSION (For loul use only) ❑ 1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC448 ❑95 UNKNOWN 44e PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT (Check one hem only) ❑2 SACRIFICIAL ANODE ❑99 OTHER SPILL AND OVERFILL YEAR INSTALLED 45a (For local meonly) TYPE(bwl use only) 45I OVERFILL PROTECTION EQUIPMENT:YEAR INS (Check all that apply) TALLED 453 ®1 SPILL CONTAINMENT 19900 3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE ®I ALARM OP W 6I-SO-4 1998 OP W 61-SO-4 ❑2 BALL FLOAT_ ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf _ IV.TANK LEAK DETECTION(A description of the monitoring program.lull be submitted a the leml ager y.) IF SINGLE WALL TANK(Check all that apply) 451 IF DOUBLE WgLI TANK OR TANK WITH BLADDER 454 (Cheek one hem only) 111 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(M TG) 111 VISUAL(SINGLE WALL M 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 0 9 OTHER _ IV.TANK'CLOSURE -- /PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/4O/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No I I PCF!1/99 revised) 175