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UN ED PROGRAM CONSOLIDATED I ,M TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank)p Page _I of TYPE OF ACTION Fl. NEW SITE PERMIT r 4. AMENDED PERMIT r 5. CHANGE OF INFORMATION) r 6. TEMPORARY SITE CLOSURE (Check one item only)I 2. OPERATOR CHANGE r New Format Request 7. PERMANENTLY CLOSED ON SITE 13. RENEWAL PERMIT (Specify reason-for local use only) (Specify change-for local use only) r 8. TANF K REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As)3 FACILITY ID# ^ 99 Shell, B&C Angle LOCATION WITHIN SITE(Optiona/)431 7700 Moreland Court, Stockton, CA 95212 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 ID# v 1 6 Yq Ci a 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK h Yes X No 4 136146-Premium 1 Owens Corning IfAYes=_.complete one page for each compartm nt. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 1989 12,000N ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE �S X 1. MOTOR VEHICLE FUEL IF 1a. REGULAR UNLEADED F 2. LEADED r 5. JET FUEL 1 (if marked,complete Petroleum Type) X 1b. PREMIUM UNLEADED r 3. DIESEL r 6. AVIATION FUEL I 2. NON-FUEL PETROLEUM IF 1c. MIDGRADE UNLEADED r 4. GASOHOL r 99. OTHER r 3. CHEMICAL PRODUCT r 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Inventory page)441 CAS#(from Hazardous Materials Inventory page) Used Oil) Yrs.• F95. UNKNOWN Ill.TANK CONSTRUCTION TYPE OF TANK Fl. SINGLE WALL I 3. SINGLE WALL WITH I 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) X2. DOUBLE WALL EXTERIOR MEMBRANE LINER 195. UNKNOWN F 4. SINGLE WALL IN A VAULT F99. OTHER TANK MATERIAL-primary tank r 1. BARE STEEL X 3. FIBERGLASS/PLASTIC F 5. CONCRETE F95. UNKNOWN 444 (Check one item only) r 2. STAINLESS STEEL r 4. STEEL CLAD W/FIBERGLASS r 8. FRP COMPATIBLE W/100%METHANOL r 99. OTHER REINFORCED PLASTIC FRP TANK MATERIAL-secondary r 1. BARE STEEL X 3. FIBERGLASS/PLASTIC r 8. FRP COMPATIBLE W1100%METHANOL F 95. UNKNOWN 445 tank r 2. STAINLESS STEEL I 4. STEEL CLAD W/FIBERGLASS r 9. FRP NON-CORRODIBLE JACKET r 99. OTHER (Check one item only) REINFORCED PLASTIC(FRP) I'10. COATED STEEL 15. CONCRETE TANK INTERIOR LINING r 1. RUBBER LINED r 3. EPDXY LINING r 5. GLASS LINING r 95. UNKNOWN446 DATE INSTALLED 447 OR COATING r 2. ALKYD LINING r 4. PHENOLIC LINING X 6. UNLINED F99. OTHER Check one item only) For local use only) OTHER CORROSION r 1. MANUFACTURED X 3. FIBERGLASS REINFORCED PLASTIC r 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC r 4. IMPRESSED CURRENT F99. OTHER (Check one item only) PROTECTION (For local use only) I 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only)451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 450 (Check all that apply) X 1. SPILL CONTAINMENT X 1 ALARM X 3 FILL TUBE SHUT OFF VALVE X 2. DROP TUBE F 2 BALL FLOAT T 4 EXEMPT X 3. STRIKER PLATE IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 I 1, VISUAL(EXPOSED PORTION ONLY) I' 5. MANUAL TANK GAUGING(MTG) r 1. VISUAL(SINGLE WALL IN VAULT ONLY) r 2. AUTOMATIC TANK GAUGING(ATG) T 6. VADOSE ZONE X2. CONTINUOUS INTERSTITIAL MONITORING I 3. CONTINUOUS ATG T 7. GROUNDWATER r 3. MANUAL MONITORING I 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ T 8. TANK TESTING BIENNIAL TANK TESTING I 99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons r Yes r No 6