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IFIED PROGRAM CONSOLIDATED FORK TANK: TA0143303 PR#: PRO231433 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0003685 (two pages per tank) TYPE OF ACTIONPage 6 of 7 (Check adv item only) ❑ I NEW SITE PERMIT E]4 AMENDED PERMIT CHANGE OF INFORMATION E]6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-far local use only) (Specify reason-for local use only) ❑8 TANK REMOVED BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Strains;As) FACILITY ID: PR#: B[1l)L`TT TL:TnOT _r ri,� k,, nd S IE12 Fx PQ 3 FA0003685 PR0231433 LOCATION WITHIN SITE(Optional) 419 S MAIN ST,MANTECA 43,1 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 ID# Tank#: 3 4;2 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0143303 MODERN WELDING If"Yes".complete one page for each caopanment. 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 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 (If marked complete Petroleum Type) ❑ 1 b.PREMIUM UNLEADED N 3.DIESEL ❑6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ I c.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials InventoryPag a CAS#(bHazardous Materials Invcntory e E]4.HAZARDOUS WASTE P ) 441 an ) 4; (In<lades used al) 68476-34-6 ❑ 95.UNKNOWN M.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 441 (Check one item only) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN 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) ` Pg-7 STAINLESS STEEL VTEEL CLAD W/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL 1 REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL .pr3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Cheek one item only) ❑2.STAINLESS STEEL PlSTEEL CLAD W/FtBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL ` REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER l ❑5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check one item only) ❑ 2 ALKYD IN LINING ❑4 PHENOLIC LING N 6 UNLINED E]99.OTHER (Fa kxel use poly) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check one item only) ❑4 IMPRESSED CURRENT N 99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use ady) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chock all that apply) ® I SPILL CONTAINMENT I,947"00 m A 1 ALARM 1 1,997.00 Ar3 FILL TUBE SHUT OFF VAL' 1,997.00 X❑ 2 DROP TUBE 4997-W (/ N 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 age .) IF SINGLE WALL TANK(Cheek all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑3 CONTINUOUS ATG ❑ 7 GROUNDWATER N 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)