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FIED PROGRAM CONSOLIDATED FORM fy.a y ANKv A0505758 (�- L :-PR0231665 ,(`I UNDERGROUND STORAGE TANKS - TANK PAGE 1 FA* rtanl0 , TYPE OF ACTION Page 2 of'7 )�I Ll TYPE OF(Cheek anh imm MW) ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT ❑5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE 7-t / ❑ 7 PERMANENTLY CLOSED ON SITE O 1 . ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED a I BUSINESS NAME(Sato a FACILITY NAME«DBA-Dotes Bai«as As) FACILITY ID: PR#: 1 LACHHAR CHEVRON* 3 FA0003714 PR0231665 LOCATION WITHIN SITE(optima) 334 E MAIN ST,RIPON 431 PHONE 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# Tank#: 6 431 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0505758 XERXES I'Yw,«mplem a«par for"acaapeemcnt DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 433 8/1/1995 12:00:OOAM 12,000 ADDITIONAL DESCRIPTION T.law au mly> 433 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® ],MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL (InaarkNaaaplam Pewleam Type) ❑ Ib.PREMIUM UNLEADED ❑3.DIESEL ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME B®x sNwu Maiaiss Inm CAS# Gwnx uaaua Mat«iab lm page)( t°r1'Pada) a41 ( eatm'P 5 ) 442 ❑4.HAZARDOUS WASTE (Ncletlausdoi) 8006-61-9 ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Ch«k a«itammty) EXTERIOR MEMBRANE LINER El 95,UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primacy tank ❑ I.BARE STEEL ® FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 444 (Chock me imm only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100'%METHANOL REINFORCED PLASTIC(FRP) ❑99 OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ®3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Chock me iron aNy) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ I.FRP COMPTIBLE WAIN/o METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑5.CONCRETE TANK INTERIOR LINING ❑ 1,RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 417 OR COATING (Ch ono imn only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Far twat uuaJy) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN "a DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (OneckaneiimoNy) E]4 IMPRESSED CURRENT E] 99 OTHER F1 2SACRIFICW.ANODE (Earl«iluc«uy) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(baloseaNy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Cluck all Nat sept,) ® I SPILL CONTAINMENT 1,995.00 ® ]ALARM ® 3 FILL TUBE SHUT OFF VAL` Q 2 DROP TUBE 1,995.00 opw 61 SO 4 ❑ 2 BALL ❑4 EXEMPT 0 3STRUGM.PLATE FLOAT IV.TANK LEAK DETECTION(A aamipam ofaummimnna pmgma.hall W submittal to no I 1 age«,.) IF SINGLE WALL TANK(Chock all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (CMcka«itae ady) ❑ 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 ❑ 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 MATERLU.7 459 ❑Yes ❑No UPCF(12/99 revised)