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FIED PROGRAM CONSOLIDATED FORM TANK: TA0504864 <br /> PR#: PR0231173 <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0006423 <br /> (two pages per tank) <br /> �.(/ Page 6 of7 <br /> TYPE OF ACTION E] INEW SITE PERMIT F14AMENDED PERMIT u S CHANGE OF MFORMAI 10\ E] 6 TEMPORARY SITE CLOSURE <br /> (C wly imnmH) y. _ ❑ ?PERMANENTLY CLOSED ON SITE <br /> tsP p wtcr la,nl me only) !vp fiirnaat-I larel ,m aJYl ❑ 8TANK REMOVED 430 <br /> ❑3 RENEWAL PERMIT <br /> BUSINESS NAME(Sameas FACBITYNAMEp DBA-Dovgemitwa n+) FACILITY ID:MAINS PR#: <br /> S 3 FA0006,1 3 PR0231173 <br /> LOCATION WITFIIN SITE(oposn 3440 E MAIN ST,STOCKTON 1//� �B 431 <br /> PHOT IES z <br /> L TANK DESCRIPTION(A p <br /> scaled plot lan with the location of the UST system including buildings and landmarks shall he submitted to the local agency.) <br /> TANK ID# Tank#: 6 43z TANK MANUFACTURER s33 COMPARTMENTALIZED TANK ❑Yes � 434 <br /> TA0504864 TRUSCO <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OFC OMPARTMENTS 437 <br /> 10/21/1993 10-10-00 1 400 e4 <br /> ADDITIONAL DESCRIPTION(F«low me mly) 43e <br /> 11.TANK CONTENTS <br /> TANKUSE 439 PETROLEUM TYPE 0°0 <br /> ® I.MOTOR VEHICLE FUEL ® Is.REGULAR UNLEADED ❑ 2.LEADED ❑ S.JET FUEL <br /> Ofautkedt lde Pe°a Twc) ❑ Ib.PREMIUMUNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL <br /> ❑2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER <br /> ❑ 3.CHEMICAL PRODUCTCOMMON NAME(rmmxma.ma Mate�,la lmmtwyp.ge) 441 CAS#(6omflam,doav Matenala m.mhay page) 442 <br /> ❑4.HAZARDOUS WASTE <br /> (Indo sUsed Oil) <br /> ❑95.UNKNOWN <br /> 111.TANK CONSTRUCTION <br /> TYPEOFTANK ❑ I.SINGLE WALL ❑ 3.SINGLE <br /> WALL MEMBRANE LINER ❑ S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> E <br /> (Clrrk me 0anwlY) ❑ 95.UNKNOWN <br /> pj?�2.DOUBLE WALE' ❑4.SINGLE WALL IN VAULT ❑99.OTHER <br /> TANK MATERIAL-palmary lank ❑ I.BARE <br /> STAINLESS <br /> �❑ <br /> FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN M4 <br /> (Check orc immmy) <br /> E] 2.STAINLESS STEEL �D '/ STIC(ESP) S.FRP COMPTIBLE W/100%METHANOL <br /> PLASTIC(FRP) ❑99.OTHER <br /> TANK MATERIAL-secondary tank ❑ <br /> I.BARE STEEL ❑ 3.MERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 9S.UNKNOWN 445 <br /> (Ch kue bvn mq) ❑ 2.STAINLESS STEEL LASS ❑ S.FRP COMPTIBLE W/100%METHANOL <br /> FORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER <br /> ❑ S.CONCRETE <br /> 447 <br /> TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 4W DATE INSTALLED <br /> OR COATING ❑99.OTHER <br /> (Cask ooe itanmty) ❑2ALKYD LINING ❑ 4PHENOLIC LINING (Falocslaaemly) <br /> 449 <br /> OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER <br /> (C3ae itmmly) ❑ 2 SACRIFICIAL ANODE (Pmlaw u4e mly) <br /> SPILL AND OVERFILL YEAR MSTALLE450 TYPE(lora)me mty OVERFILL PROTECTION EQUIPMENT INSTALLED <br /> (Check all that apply{' PILL CONTAINMENT ❑ IALARM NBE SHUT OFFV <br /> 2 DROP TUBE ❑ 2HALL ❑ 4EXEMPT <br /> ❑ 3 STRIKER PLATE FLOAT <br /> FV.TANK LEAK DETECTION(Ado of anOs a ebanbe aubt�ttdmdsbw agaic3'.) <br /> I fiat appy) IF DOUBLE WALL TANK OR TANK WITH BLADDER <br /> (Lhrkmeitwamly) <br /> S SE FOR ON ON 5 M UAL ANK GAUG G(MTG) <br /> ❑ 1 'UAL(SINGLE WALL IN VAULT ONLY) <br /> A M I T GA ING( ) 63 SSE ONE <br /> S T OIIN \ ATER OUS INTERSTITIAL MONITORING <br /> 4 T Y RE N TI 'S G ❑3 MANUAL MONITORING <br /> (SIR)B IAL TANK TES MG ❑ 99 OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> ❑Yes ❑ No <br /> UPCF(12/99 revised) <br />