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IFIED PROGRAM CONSOLIDATED FORro �/ l U 3 03 TANK: TA0505044 PR#: PR0231459 UNDERGROUND STORAGE TANKS -TANK 1/�U y` FAC#: FA0003677 0 K. //// (two pages per tank) Page 4 of TYPE OF ACTION El NEW SITE PERMIT ❑4 AMENDED PERMIT 5 CHANGE OF INFORMATION ❑6 TEMPORARY SITE CLOSURE (G -aNiwnaaH) ❑ '!PERMANENTLY CLOSED ON SITE ❑3RENEWAL PERMIT ❑STANK REMOVED 430 BUSINESS NAME(sm.M FwcarrY NAME m oeA-Doing Buaiaw as) FACILITY ID: PR#: 1 GAS DEPOT 3 FA0003677 PR023I459 LOCATION W ITHN SITE(opdma0 824 E YOSEMITE AVE,MANTECA 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan witb the location of the UST system including buildings and landmarks shall be submitted W the local agency.) TANK ID# Tank#: 6 432 TANK CTU`RE/R j� 433 COMPARTMENTALIZED TANK yes ❑No 434 TA0505044 �FK us If-Ya:waPiaraaepagcr�cwsp rnt. DATE RUST D(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 432 Z 6,000 ADDITIONAL ES ON(Fm1ou1 oaq) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE q4p ® I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifnukal aanPPlele Peaolavn Tyre) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM le.MIDGRADE UNLEADED E] 4.GASOHOL 499.OTHER F13.CHEMICAL PRODUCT OMMON NAME(6raa HaaNda Matniab lavmtuy pap.) MI CAS#(6unllavtdm Maum.b Nvmto,page) 442 ❑4.HAZARDOUS WASTE (ndudmuaeam) PLUS ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 413 (�uoeienayy) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑".OTHER TANK MATERIA.-prinury tank ❑ I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN a44 ([ oncimnooly) ❑ 2.STAINLESS STEEL ® STEEL CLAD W/MERGLASS ❑ a.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99 OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Lla itaumly) ❑ 2.STAINLESS STEEL 4.STEEL CLAD W/FIBERGLASS ❑ a.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ L RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED M7 OR COATING (Cberkooeimnmly) ❑ 2ALKYD LINING ❑ 4PHENOUCLINING ❑6UNLINED ❑ 99.OTHER (Palod uc mb) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 443 DATE INSTALLED M9 PROTECTION IF APPLICABLE PROTECTION (Ua .nanmN) E]4 IMPRESSED CURRENT E] 99 OTHER ❑2SACRIFICIAL ANODE (For lanl tae mty) SPILLANDOVERFILL YEAR INSTALLE450 TYPE(Iaalu cely) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (0�endw wty) I SPILL CONTAINMENT El ALARM 3 FILL TUBE SHUT OFF VAL' 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d crpdmofOunmutmingpm®amSWI besubnimi to Ircal egmcy.) IF SINGLE WALL TANK(Chalc all not amply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ "OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIA.? 457 ❑Yes ❑ No UPCF(12/99 revised)