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0 IFIED PROGRAM CONSOLIDATED FOR TANK: TA0143302 PR#: PR0231433 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0003685 (two pages per tank) TYPE OF ACTIONPage 4 of 7 (Check only item onh9 ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT S CHANGE OF INFORMATION ❑6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify mum-for local use only) (spedFrcason-forlocaluseonly) ❑8TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: 130VETT DETR0 Er ra,r_ awl K SFQVL jCQ 3 FA0003685 PR0231433 LOCATION WITHIN SITE(Optional) 419 S MAIN ST,MANTECA 411 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 MANUFACTURER 473 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0143302 MODERN WELDING If"Yes",complete one page for each cornpamnent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10/22/1985 12:00:OOAM 10,000 ADDITIONAL DESCRIPTION(For low use only) 419 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 410 ® 1.MOTOR VEHICLE FUEL ❑ 1 a.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL (Ifmarked complete Petroleum Type) ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ 1 c.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(From Haiardous Materials Im-tory page) 44l CAS#(from Hazardous Materials Invent�page) 442 ❑4.HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN IIL TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check are 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) J .®^f STAINLESS STEEL jj'$TEEL CLAD W/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL .RR1 FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Check one item only) ❑ 2.STAINLESS STEEL �4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/IOD%METHANOL 1 REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ L RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check one itan only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (For Meal use only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check one flan only) C]4 IMPRESSED CURRENT ® 99 OTHER ❑ 2 SACRIFICIAL ANODE (For Mal use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ® I SPILL CONTAINMENT 1,997.00 M44" 2 w. 'y ® 1 ALARM 1,997.00 FILL TUBE SHUT OFF VAL' 1,997.00 x❑ 2 DROP TUBE 1,997.00 L1___ ® 2 BALL 1,997.00 ❑4 EXEMPT X❑ 3 STRIKER PLATE 1,997.00 FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that appy) 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 ❑Yes ❑No UPCF(12/99 revised)