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w <br /> ified Program Consolidated F <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE <br /> (one page per nnK) <br /> Page_of <br /> TYPE OF ACTION [:]1.NEW SITE PERMIT [j4.AMENDED PERMIT E-15.CHANGE OF INFORMATION 116.TEMPORARY SITE CLOSURE <br /> (CHECK ONF ITFM rWl VI <br /> �7. PERMANENTLY CLOSED ON SITE <br /> X13.RENEWAL PERMIT �8.TANK REMOVED <br /> (Speedy reason-forlocal use only) (Speedy reason-for tical use only) 430 <br /> BUSINESS NAME(Sam as FACILITY NAME or DBA-Doing Business As) 3 FACILITYID# <br /> Jackpot Food Mart, Manteca <br /> LOCATION WITH SITE(0 onep FT. 431 <br /> 1y34 W. vo5fm Vie. Avg <br /> 7, I TANK DESCRIPTION <br /> TANKIDK 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK DYes X❑No 434 <br /> 1 f (p5C 0 Modern Welding Yes'complete one page for each compartment <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 9/91 8000 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> 11, TANK CONTENTS <br /> 1; 1 <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ® 1. MOTOR VEHICLE FUEL 01a, REGULAR UNLEADED [:]2. LEADED E]5. JET FUEL <br /> (If marked,complete Petroleum Type) <br /> [:] 2. NON-FUEL PETROLEUM ®1b.PREMIUM UNLEADED [:]3. DIESEL [:]6. AVIATION FUEL <br /> ❑ 3. CHEMICAL PRODUCT [:]1c.MIDGRADE UNLEADED []4. GASOHOL [:]99. OTHER <br /> E-1 4. H KUUUJ WAa m pnauaes COMMON NAME prorn Hazardous Matenals Inventory page Hazardous Matenals Inventory page <br /> Used Oil) <br /> L]95. UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK 1:11, SINGLEWALL E-13. SINGLE WALL WITH 115. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> EXTERIOR MEMBRANE LINER EXTERIOR MEMBRANE LINER <br /> (Check on dem only) ®2. DOUBLE WALL 04. SINGLE WALL IN A VAULT [-]6. UNKNOWN <br /> E]99.OTHER <br /> TANK MATERIAL-plinary tank 01.13ARESTEEL [:]3.FIBERGLASSIPLASTIC [:]S.CONCRETE ❑95. UNKNOWN 444 <br /> EXTERIOR MEMBRANE LINER <br /> (Check on dem only) 1:12. STAINLESS STEEL 04. STEEL CLAD [:]8. FRP COMPATIBLE W1100%METHANOL E]99.OTHER <br /> W/FIBERGLASS <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-secondary tank ®1.BARE STEEL E]3.FIBERGLASS/PLASTIC 1:18. FRP COMPATIBLE W/100%METHANOL []95. UNKNOWN 445 <br /> (Check on dem only) ❑2. STAINLESS STEEL E:]4. STEEL CLAD WIFIBERGLASS [:]9.FRP NON-CORROSNE JACKET []99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> E]b. GUNUHEIE CUAIEUJIEEL <br /> TANK INTERIOR LINING Ell.RUBBER LINED E:]3.EPDXY LINING [:]5.GLASS LINING C]95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING <br /> ❑2. ALKYD LINING E]4.PHENOLIC LINING [:]fi.UNLINED [-]99.OTHER <br /> (Check one dem only) (Forlocal use only) <br /> OTHERCORROSION 448 DATEINSTALLED 449 <br /> PROTECTION IF APPLICABLE [31.MANUFACTURED CATHODIC E:]3.FIBERGLASS REINFORCED PLASTIC E]95.UNKNOWN <br /> PRUIEOIIUN <br /> (Check all that apply) [32.SACRIFICIAL ANODE [:]4.IMPRESSED CURRENT 099.OTHER or causeony <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(Far local use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Check on dem only) ®1.SPILL CONTAINMENT 1991 451 [:11.ALARM - ®3.FILL TUBE SHUT OFF VALVE <br /> ®2.DROP TUBE 1991 1:32.BALLFLOAT _ C]4.EXEMPT <br /> [:]3.STRIKER PLATE <br /> TANK LEAK DETECTION <br /> IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one dem only): <br /> F-11.VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) []1.VISUAL(SINGLE WALL IN VAULT ONLY)) 454 <br /> 02.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING <br /> F13.CONTINUOUS ATG []7.GROUND WATER []3.MANUAL MONITORING <br /> F-14.STATISTICAL INVENTORY RECONCILIATION(SIR)' F8.TANK TESTING <br /> 099.OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE Ilrr <br /> ESTIMATED DATE LAST USED(YWMO/DAT) 445 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> gallons DYes E]No <br /> UPCF(199) Formerly S W RCB Form B <br />