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IED PROGRAM CONSOLIDATED FORM o I'Sl) TANK: TAOS156151 �/ PR#: PROS8114 UNDERGROUND STORAGE TANKS - TANK PAGE 1 N FAC#: FA0013700 (two pages per tank) TYPE OF ACTIONPage 2 of 5 (CNcx mNiun onh9 E] I NEW SITE PERMIT ❑ 4:A4FvULDPFRvIIT E] 5('H,VJGFOF1NFORV1kT10,N ❑ 6 TEMPORARY SITE CLOSURE ` ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT S«i r x folo6hwonhl Sp h noa'«Iowl cwN) STANK REMOVED 430 BUSINESS NAME(S.mc u FACILITY NAME«DBA-Doug Business As) FACILITY ID'. PRF: 1 MINER&HUNTER PROJECT FA0013700 PR0518114 LOCATION WITHIN SITE(op i u 148 E MINER STOCKTON 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 1D9 Tank#: 1 431TANK MANUFACTURER 439 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0515615 I("Y®",c«nplek o«Page r«a:a wmp4mmnr. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 200 1 ADDITIONAL DESCRIPTION(F«local uwoah) 438 EL TANK CONTENTS TANK USE 439 PETROLEUM TYPE aao ❑ I.MOTOR VEHICLE FUEL ❑ ]a REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL ufnudedm ].Mmkom T)pe) ❑ It, PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL M 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADEUNLEADED ❑4.GASOHOL ® 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(I.Ha.<monS Muedals lmmu-Page) 441 CAS#(f-Hm esnJs Mnndds1.,vn rPage) E]4.HAZARDOUS WASTE a42 (1_1 «Uses au ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK M 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cliok«mircrn Doti) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ❑ 2.DOUBLE WALL ❑4.SINGLE WALL M VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE 95."KNOWN 444 (Clszk wmitcmmh) ❑ 2.STAINLESS STEEL ❑STEEL CLAD W/FTBERGLASS ❑ 8.FRP COMPTIBLE W/I(K%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1,BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE E195,UNKNOWN 445 (CIckm tan«Jy) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLADW/FIBERGLASS ❑ 8.PRP COMPTIBLE W/IXtX,METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LMED ❑ 3. a47 OR COATING EPDXY LMMG ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED fCM1xkiinn mh) ❑ 2ALKYD LINING ❑4PHENOLIC LMMG ® 6UNLINED ❑ 99.OTHER (F«lain use«Jy) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REMFORCED PLASTIC95 UNKNOWN 448 DATE INSTALLED a9 PROTECTION IF APPLICABLE PROTECTION ❑ (Caeek mriwn on h) ❑ 23ACRIFICIAL ANODE E]4 IMPRESSED CURRENT ❑ 99 OTHER (F«IOW wa aJy) SPILL AND OVERFILL YEAR INSTALLEI50 TYPE(IOWuscmh) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (L'heck all dwµyh) ❑ I SPILL CONTAINMENT ❑ I ALARM ❑ 3 FILL TUBE SHUT OFF VAV ❑ 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d .,ucn ofine nwnitadng«.,-m boll tecia.ndwds bul aggne7.) IF SINGLE WALL TANK(CB all apph) 453 IF DOUBLE WALL TANK ORTANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) E] 5 MANUAL TANK GAUGING(INTO) (Ch one non ank) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL M VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING (SIR)BIENNIAL TANK TESTING ❑99OTHER El3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR CMAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH MERT MATERIAL' 457 12/14/2001 12:00:OOAM 0.00 gallons E]Yes ❑ No UPCF(12/99 revised)