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o I' ID - zy-D2 <br /> Alk <br /> ified Program Consolidated Fo ��D�o2q/D� <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> tone page per sllel <br /> Page_of_ <br /> TYPE OF ACTION 1.NEW SITE PERMIT 1-14.AMENDED PERMIT 1:15.CHANGE OF INFORMATION 1:16.TEMPORARY SITE CLOSURE <br /> ICHFCK ONE ITEM ONI YI 1-17. PERMANENTLY CLOSED ON SITE <br /> XX3.RENEWAL PERMIT ❑B.TANK REMOVED <br /> (Specify reason-for local use only) (Specify reason-for local use only) 430 <br /> BUSINESS NAME(Sam as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# <br /> Jackpot Food Mart,Manteca <br /> LOCATION WITH SITE(Options] 431 <br /> Iq'3 v Owern( r <br /> t, I.TANK DESCRIPTION <br /> TANK ID# N432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes X]No 434 <br /> 1? 6D�I Modern Welding If-Yes-conpleteone page for eachconpartmenl <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 9/9112000 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> II: TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> © 1. MOTOR VEHICLE FUEL [!:]la. REGULARUNLEADED 112. LEADED 05. JET FUEL <br /> (If marked,complete Petroleum Type) <br /> 2. NON-FUEL PETROLEUM [:]1b.PREMIUM UNLEADED []3. DIESEL 1:16. AVIATION FUEL <br /> 3.CHEMICAL PRODUCT 01c.MIDGRADE UNLEADED [:]4. GASOHOL E]99. OTHER <br /> 4. r1AGAK000S WAe l t(includes (from Haleardous Minerals inventory page rom Hazardous Materials Immtory page <br /> used Un) <br /> D95- UNKNOWN <br /> III. TANK CONSTRUCTION <br /> WEE OF TANK E31. SINGLE WALL E]3. SINGLE WALL W ITH [:]5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> p-I EXTERIOR MEMBRANE LINER EXTERIOR MEMBRANE LINER <br /> (Check on dem IJ <br /> only) 2. DOUBLE WALL E]4. SINGLE WALLIN A VAULT 1:16. UNKNOWN <br /> E:]99.OTHER <br /> TANK MATERIAL-primary tank 1.BARE STEEL [:13.FIBERGLASSIPLASTIC ❑5.CONCRETE ❑95. UNKNOWN 444 <br /> EXTERIOR MEMBRANE LINER <br /> (Check on Rem only) 02. STAINLESS STEEL ®4. STEEL CLAD ❑B. FRP COMPATIBLE W/1100%METHANOL [-]99.OTHER <br /> W/FIBERGLASS <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-secondary tank ®1.BARE STEEL [:]3.FIBERGLASSIPLASTIC [:]8. FRP COMPATIBLE W1100%METHANOL E]95. UNKNOWN 445 <br /> (Check on dem only) [:]2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS [-]9.FRP NON-CORROSNE JACKET 099.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> Elb. GUNUKLIE [:]10. GUAIEUSILLL <br /> TANK INTERIOR LINING 1.RUBBER LINED 03.EPDXY LINING [:]5.GLASS LINING [:]95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING <br /> ❑2. ALKYD LINING ❑4.PHENOLIC LINING ®6.UNLINED [:]99.OTHER <br /> (Check one dem only) (Forlocal use only) <br /> OTHER CORROSION 448 DATEINSTALLED 449 <br /> PROTECTION IF APPLICABLE []I.MA UFA(CNURED CATHODIC [:]3.FIBERGLASS REINFORCED PLASTIC [:]95.UNKNOWN <br /> (Check all that apply) �2.SACRIFICIAL ANODE 04.IMPRESSED CURRENT []99.OTHER r cause ony <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(Far local use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Checkondemonly) ®1.SPILL CONTAINMENT 1991 451 [:]1.ALARM _ O3.FILL TUBE SHUT OFF VALVE <br /> ®2.DROP TUBE 1991 E:]2.BALLFLOAT _ ❑4.EXEMPT <br /> �3.STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> IF SINGLE WAIL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one Rem only): <br /> [:]1.VISUAL(EXPOSED PORTION ONLY) 1:15,MANUAL TANK GAUGING(MTG) 1:11.VISUAL(SINGLE WALL IN VAULT ONLY)) 454 <br /> ❑2.AUTOMATIC TANK GAUGING(ATG) [:]6.VADOSEZONE ®2.CONTINUOUS INTERSTITIAL MONITORING <br /> M3.CONTINUOUS ATG [:]7.GROUND WATER 1:13.MANUAL MONITORING <br /> M4.STATISTICAL INVENTORY RECONCILIATION(SIR)' ❑B.TANK TESTING <br /> ❑99.OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRIMOIDAT) 445 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> gallons Yes E]No <br /> UPCF(199) Formerly SWRCB Form B <br />