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b\NL 10 IMF UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (two pages pertank) Page 'o of 3 TYPE OF ACTION F 1.NEW SITE PERMIT F 4. AMENDED PERMIT F S. CHANGE OF INFORMATION) r 6. TEMPORARY SITE CLOSURE (Check one item only)F 2. OPERATOR CHANGE F 7. PERMANENTLY CLOSED ON SITE X 3. RENEWAL PERMIT (Speclly reason-for local use only) (Specify change-for local use ordy) r 8. TANr K REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As)3 FACILITY ID Ripon Shell LOCATION WITHIN SITE(Optional)431 341 E. Main Street, Ripon,CA 95366 L TANK DESCRIPTION (A sra/ad pkat plan with the location of the UST system including buildings and landmarks shalt be submitted to the local agency.) TANK ID# ®50 L O'.A 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK F Yes X No 434 135816-Premium Xerxes If AYeaw,complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1996 15,000 On ADDITIONAL DESCRIPTION(Forlocal use only) 438 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 X 1. MOTOR VEHICLE FUEL F la. REGULAR UNLEADED F 2. LEADED - r S. JET FUEL (Umarked,complete Petroleum Type) X ib. PREMIUM UNLEADED 3. DIESEL r 6. AVIATION FUEL r 2. NON-FUEL PETROLEUM r 1c. MIDGRADE UNLEADED F 4. GASOHOL F 99, OTHER r 3. CHEMICALPRODUCT F 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Imventory page)441 CAS#(from Hazardous Materials lnv ntory page) 442 Used oil) F95. UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK F 1. SINGLE WALL F 3. SINGLE WALL WITH F S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) X 2. DOUBLE WALL EXTERIOR MEMBRANE LINER F95. UNKNOWN F 4. SINGLE WALL IN A VAULT F99. OTHER TANK MATERIAL-primary tank r 1. BARE STEEL X3. FIBERGLASS/PLASTIC r 5. CONCRETE F 95. UNKNOWN 444 (Check one item only) r 2. STAINLESS STEEL r 4. STEEL CLAD WIFIBERGLASS r B. FRP COMPATIBLE W1100%METHANOL r99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary F" t BARE STEEL X3. FIBERGLASS I PLASTIC F 8. FRP COMPATIBLE W/100°A METHANOL r 95. UNKNOWN 445 tank F 2 STAINLESS STEEL F 4. STEEL CLAD WIFIBERGLASS F 9. FRP NON-CORRODIBLE JACKET r 99. OTHER (Check one item only) REINFORCED PLASTIC(FRP) F 10 COATED STEEL F 5. CONCRETE TANK INTERIOR LINING r 1. RUBBER LINED F 3. EPDXY LINING r 5. GLASS LINING F 95. UNKNOWN446 DATE INSTALLED 447 OR COATING F 2. ALKYD LINING F 4 PHENOLIC LINING X 6. UNLINED F 99. 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 PROTECTION r 4. IMPRESSED CURRENT r99. OTHER (Check one item only) (For local use only) T-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_1996_ X 1. ALARM _1998 X 3. FILL TUBE SHUT OFF VALVE_1996_ X2. DROP TUBE 1996 F 2. BALL FLOAT F L EXEMPT X 3. STRIKER PLATE 1996 f 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 r 1, VISUAL(EXPOSED PORTION ONLY) r S. MANUAL TANK GAUGING(MTG) F 1. VISUAL(SINGLE WALL IN VAULT ONLY) F 2. AUTOMATIC TANK GAUGING(ATG) F 6. VADOSE ZONE X 2 CONTINUOUS INTERSTITIAL MONITORING F 3, CONTINUOUS ATG F 7 GROUNDWATER F 3. MANUAL MONITORING F 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ F 8. TANKTESTING BIENNIAL TANK TESTING I r 99. OTHER V.TANK CLOSURE INFORMATION t PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MOIDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallon F Yes F No UPCF(1/99 revlsed) Formerly S\ARCB Form B 6 S 'd ir96S-LLS-60Z jysegnJeW •1 eonig dSz :80 20 Be .add