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\2�IA G(Q I PIED PROGRAM CONSOLIDATED FORM ,1�1,VtFAC#: TANK: TA0515616 --.e `/ PRO: PRO518114 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FA0013700 (two pages per tank) TYPE OF ACTIONPage 4 of 5 (Chw mkonbnonN) ❑ INEW SITE PERMIT E] 4AMLWE1 D PLRNF ❑ 5 C'HAMiF OF IVF(IRMATION ❑6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT (Spx'fy rcawn-fia kmluu mW) f5penty inxu-fool t b) ANK REMOVED 430 BUSINESS NAME(S.me n FACILITY NAME or DBA-Dong Busirnss As) FACILITY ID: PRN: 1 MINER&HUNTER PROJECT FA0013700 PR0518114 LOCATION WITHIN SITE(optimal) 148 E MINER STOCKTON 431 PHONE 1.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#: 2 432 TANK MANUFACTURER493 COMPARTMENTALIZED TANK ❑Yes E]No 434 TA0515616 If-Yes-.rnnptc c on,pegs im rich cowpsommt. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 300 1 ADDITIONAL DESCRIPTION(Fm local um unb) 438 D.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 44o ❑ I.MOTOR VEHICLE FUEL ❑ 1 a.REGULAR UNLEADED ❑ Z LEADED ❑ 5.JET FUEL ptn.rtrni r®pae Pardeum T.pc) ❑ 1 b.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ®2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL ® 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(B000 Hererkine Mamrols lmmtmy Wgc) 441 CAS#(fmminndme Mnmialekrs..page) 442 ❑ 4.HAZARDOUS WASTE (ImluderUa Oil) ❑ 95.UNKNOWN M.TANK CONSTRUCTION TYPE OF TANK ® 1.SINGLEWALL ❑ 3.SINGLE WALL WITH El 5,SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cl our fwn Mutt EXTERIOR MEMBRANE LINER ❑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 (Clink.loon unh) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD WTBERGLASS ❑ 8.FRP COMPTIBLE W/IDU.METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary taNe ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN as lCMk oou loon nils) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD WTIBERGLASS ❑ 8.FRP COMPTIBLE W/IDU.METHANOL REINFORCED PLASTIC(FRP) ❑ 10 COATED STEEL ❑ 99.OTHER ❑5.CONCRETE TANK INTERIOR LINING ❑ 1,RUBBER LINED ❑ 3.EPDXY LINING "7OR COATING ❑ 5.GLASS LINING ❑95.UNKNOWN a4s DATE INSTALLED (L cee nen may) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑W,OTHER (Fm krd nc mav) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC95 UNKNOWN 44g DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ ynaokaenaicxd,) ❑ 4 IMPRESSED CURRENT E] WOTHER❑ 25ACRIFICIAL ANODE (Fm lural ummly) SPILL AND OVERFILL YEAR INSTALLB450 TYPE(hocaluuonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (C6mk d1 doo wpb,) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL` ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A 4ewsip on of lne nwnuoring ac r n dial Is,.ubnm t w ae kcal agenn.) IF SINGLE WALL TANK(Ch k on do,e1gN) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Cbmk melwn ooh) ❑ 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 ❑ 8TANK TESTING (SIR)BIENNIAL TANK TESTING E-]3 MANUAL MONITORING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MOMAY) 455 ESTIMATED QUANTITYOFSUBSTANCE REMAINING 455 TANK FILLED WITH INERT MATERIAL? 457 12/14/2001 12:00:OOAM 0.00 gallons ❑ren ❑ No UPCF(12/99 revised)