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UNIFIED PROGRAM CONSOLIDATED FORM L07UNDERGROUND STORAGE TANKS TANK PAGE 1 TANKS F 3 7) 7 (two pages per tank) TYPE OF ACTION 111 NEW SITE PERMIT ❑ 4 AMENDED PERMITPage I of 6 ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chink one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ J RENEWAL PERMIT (gpaity mwn-forbid uuonly) (Specify reason-forbal use Doty) ❑ g TANK REMOVED ame BUSINESS NAME(Su FACILITY NAME or DRA-Doing Business As) 430 3 FACILITY ID: Q I) Chevron Station#200764 0 0 0 0 0 0 0 0 0 1 LOCATION WITHIN SITE(Optbnaq 4747 West Lane,Stockton CA 95210 431 L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TK Tn D aqv �a COMPA El TANK MANUFACTURER 4v COMPARTMENTALIZED TANK Yes No 434 d� �I , OWENS CORNING Irve: complete one page for each em DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 mparsmem. NUMBER OF COMPARTMENTS 9/28/90 12,000 1 0370 ADDITIONAL DESCRIPTION(For kwal use only) 438 TANK USE 439IL TANK CONTENTS PETROLEUM TYPE ®1. MOTOR VEHICLE FUEL ®Ia. REGULAR UNLEADED ❑2. LEADED as (Ifmarkd complete Peuolam Type) ❑5. TET FUEL ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑to MMGRADE UNLEADED ❑4. GASOHOL 1199.OTHER _ ❑3. CHEMICAL PRODUCT COMMON NAME (ficin Hausdotn Materiab Immro NI ❑4. HAZARDOUS WASTE rypage) CAS#(from Har4rdous Materiels lnventorypag<) 442 Onebdes Usedoil> REGULAR UNLEADED ❑95.UNKNOWN 800-61-9 [II. TANK CONSTRUCCION TYPE OF TANK 1. SINGLE WALL ❑3. SINGLE WALL WITH (Check one han only) EXT115. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 EXTERIOR MEMBRANE LINER ❑95. UNKNOWN N 2. DOUBLE WALL ❑4. SINGLE WALL IN VAULT ❑99. OTTER_ TANK MATERIAL-primary tastk ❑1. BARE STEEL0 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 (Cheelt oae item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑�'OTIffR TANKMArEWAL-secondeytudt U BARESTEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE [195. UNKNOWN 445 (Check one aero only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS []8. FRPCOMPATBLE W/100%METHANOL ❑99.OTBER REINFORCED PLASTIC(FRP) 1110.COATED STEEL [IS. CONCRETE TANK INTERIOR LINING ❑I.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED INSTALLED 447 (Check one hem only) ❑99 OTHER (For bul uu only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN a48 "a PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT 1199 OTHER (Chink am hem only) ❑2 SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450 (Forbal use only) TYPE(Iwalureonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ®1 SPILL CONTAINMENT 19900 3 FILL TUBE SHUT OFF VALVE ®I ALARM OPW 61-SO-4 ®2 DROP TUBE 1998 OP W 61-SO4 ❑2 BALL FLOAT_ ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf _ IV.TANK LEAK DETECTION(A dmaiptbn ofthe ring program shall be submetal so the bat agency.) IF SINGLE WALL TANK(check,n sha4 apply) 453 53 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING MTG (Check rote hem only) ❑2 AUTOMATIC TANK GAUGING ATG ( ) ❑I VISUAL(SINGLE WALL TI VAULT ONLY) (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 E$TTMATED QUANTffY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No I IPCF(1/99 reviged) 171