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0 fmFIED PROGRAM CONSOLIDATED FORM //n I (0ANK: TA0505759 PR PR0231665 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FA TYPE OF ACTION Chak only item only) ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ®3 RENEWAL PERMIT ® ❑8TANNREMOVED CLOSED ON SITE El 43D BUSMSSNAME(Se NFACILITYNAME«DBA-Doing Bmi«tss Aa) FACILITY ID: PR#: I LACHHAR CHEVRON* FA0003714 PR0231665 LOCATION WITHIN SITE(clpdmep 334 E MAIN ST,RIPON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subadt ed to the local agency.) TANK ID# Tank#: 7 43z TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ❑No 434 TA0505759 XERXES I"=',mmplpco«pegsachmmpmmmt. DATE INSTALLED(YEAR/MO) 433 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 8/1/1995 12:00:OOAM 12,000 ADDITIONAL DESCRIPTION(F«Imal am owy) 438 D.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® L MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ihns.kMm Iasepelmlmm Type) ® Ib.PREMIUMUNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ le MIDGRADE UNLEADED ❑ 4.GASOHOL ❑W.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME umm xaoudmes Malcdals lmct«y pegs) 441 CAS#(6om xa mame Mabia6ly xnmry page) ❑4.HAZARDOUS WASTE 4n (1«Iwauaedop) 8006-61-9 ❑95.UNKNOWN UL TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 44 (Chakmciivn my) EXTERIOR MEMBRANE LINER El 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL ® FIBERGLASS/PLASTIC ❑5.CONCRETE ❑ 95.UNKNOWN 444 (Chackme item only) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FTBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ L BARE STEEL ® 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Chechomitem retry) ❑2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGIASS ❑ 8.FRP COMPTIBLE W/107%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 "7 OR COATING (Clack.iten red,) ❑2ALKYD LINING ❑ 4PHENOLIC LINING 916UNLINED ❑ 99.OTHER (For local use only) OTHERCORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UN1NOWN "a DATE INSTALLED 445 PROTECTION IF APPLICABLE PROTECTION (Click ore item my) E] 4 IMPRESSED CURRENT El99OTHER❑ 2SACRIFICW.ANODE (F«I«aluu«dy) SPILL AND OVERFILL YEAR MSTALLE450 TYPE(Inialnmmy) 451 OVERFILLPROTECTION EQUIPMENT'YEARINSTALLED 452 (Clack ill J�at tsps],) M 1 SPILL CONTAINMENT 1,995.00 ® I ALARM ®3 FILL TUBE SHUT OFF VAL` 1f❑ 2 DROP TUBE 1,998.00 OP W 61 SO 4 ❑ 2 BALL ❑4 EXEMPT ❑X 3 STRIKER PLATE FLOAT TV.TANK LEAK DETECTION(A c1mriptim ofwc mo h-,p,,g=shall k sumnnmd to the local egad y.) IF SINGLE WALL TANK(Cheskell that tsps],) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chan*one inial mly) ❑2AUTOMATIC TANK GAUGING(ATG) ❑ fiVADOSE ZONE ❑ 1 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) 453 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 437 ❑Yes ❑ No UPCF(12/99 revised)