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ATED PROGRAM CONSOLIDATED FOO TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (Two pages per tank) Page 1 of 2 TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one actor only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify rrnvon) (Specify reason) ❑ 9.TANK REMOVED BUSINESS NAME(seme as FACILITY NAME or DBA-Doing Businesa As) 3. 1 FACILITY ID: 1. A-1 LI UOR&GAS LOCATION WITHIN SITE(Optional) 431. 420 WEST YOSEMITE AVENUE,MANTECA, CA 95337 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.) TANK ID# 432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK ®Yes ❑ No 434. TA0508098 XERXES If"Yon,"wmplete one page for each compartment. DATE INSTALLED 435, TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 (YEAR/MO) 1999 6,000 TWO ADDITIONAL DESCRIPTION(For 1«al use only) 438. II.TANK CONTENTS TANK USE 439. PETROLEUM TYPE 440. ® 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (lfchwked,corrylete Petroto.Type) ®Ib. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑ to. MIDGRADE UNLEADED [14. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (son,Haaardous Materials Inventory page) 441' CAS#(from Hazardous Materials Inventory page) 442. ❑ 4. HAZARDOUS WASTE GASOLINE 8006-61-9 (Includes Used Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WI II INTERNAL BLADDER SYSTEM 443_ (Check one item only) MEMBRANE LINER El 95. UNKNOWN ®2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primarytenk ❑I. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCEDPLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary tank El 1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL [195.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL[14. STEEL CLAD W/FIBERGLASS [19. FRP NON-CORRODA13LE JACKET [199.OTHER REINFORCED PLASTIC(FRP) [110. COATED STEEL ❑ S. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED [13.EPDXY LBVING ®5.GLASS LINING [195.UNKNOWN 446. DATE INSTALLED "T OR COATING ❑2.ALKYD LINING [14.PHENOLIC LINING ❑6.UNLINED [199.OTHER Check one item only) OTHER CORROSION ❑ 1.MANUFACTURED CATHODIC ®3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN "S. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT [199.OTHER IfApplicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451, OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) ®L SPILL CONTAINMENT 1999 ® 1.ALARM 1999 ®3.FILL TUBE SHUT OFF VALVE 1999 ®2.DROP TUBE 1999 ®2.BALL FLOAT 1999 ❑4.EXEMPT [13.STRIKER PLATE IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK 453- IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) Cl 6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑7.GROUNDWATER [13.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING El 99. OTHER V.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_ N/A N/A gallons ❑Yes ® No UPCF hwfwrc-b(1/99)-1/4 http://www.unidoes.org Rev.02/16/00