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NIFIED PROGRAM CONSOLIDATED FOR TANK: TA0515606 PR#: PR0517565 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0013503 (two pages per tank) Page (CheckTYPE onF item only) ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT ❑5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWALPERMIT (SpeciPoreason-forlocaluxody) (speci(ytetsan-forloralusconly) ❑8TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: SAFEWAY#2600 3 FA0013503 PR0517565 LOCATION WITHIN SITE(Optionai) 1987 W I ITA ST,TRACY 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#: 1 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [:]Yes ❑No 434 TA0515606 MODERN WELDING CO INC If"Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 20,000 ADDITIONAL DESCRIPTION(For local use only) 438 EL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ® I a.REGULAR UNLEADED ❑ 2.LEADED ❑5.JET FUEL (Ifmarkedcomplete Petroleum 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(from Hazardous Materials Inventory page) 441 CAS#(tram Hazardous Materials Imerttory page) 442 ❑4.HAZARDOUS WASTE (Includes Used oil) 8006-61-9 ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) 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 (Check one item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99,OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ® 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Chock one item only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED E] 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check one item only) E]2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑ 99.OTHER (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED -9 PROTECTION IF APPLICABLE PROTECTION (Check one item only) ❑4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2 SACRIFICIAL.ANODE (Fa local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) M I SPILL CONTAINMENT 2,001.00 PHIL-TITE85000 ® 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL` 7C❑ 2 DROPTUBE 2,001.00 OPW 61T-7368 ® 2 BALL ❑4 EXEMPT Q 3 STRIKER PLATE 2,001.00 MODERN WELDINI FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check as that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE 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) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 10/16/2001 12:00:OOAM 0.00 gallons ❑Yes ❑No UPCF(12/99 revised)