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IFIED PROGRAM CONSOLIDATED FORN8 TANK: TA0508418 <br /> j PR#: PR0231876 <br /> UNDERGROUND STORAGE TANKS,7NK PAGE t FAC#: FA0000421 <br /> LLt (�A - (two pages per tank) <br /> /? Page 2 of 7 <br /> TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANGE OF INFORMATION ❑ 6 TE P7O RY SITE CLOSURE <br /> (Check only itern only) <br /> r '' ypw`'9 ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACR.fry NAME or nen-Doing Business As) FACILITY ID: PR#: 1 <br /> MANTECA BEACON 3 FA0000421 PR0231876 <br /> LOCATION WITHIN SITE(Optional) 1001 E YOSEMITE AVE,MANTECA 431 <br /> PHONE <br /> 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.) <br /> TANK ID# Tank#: 5 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes ❑No 434 <br /> TA0508418 FLUID CONTAINMENT le'Yes",complete one page for each compaMenrt. <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 8,000 Z_ <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> H.TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ® 1.MOTOR VEHICLE FUEL ❑ I a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL <br /> (If narked conQlete Petroleum Type) <br /> Ib.PREMIUM UNLEADED "'''"���'''����3.DIESEL ❑ 6.AVIATION FUEL <br /> ❑ 2.NON-FUEL PETROLEUM [:] I c.MIDGRADE UNLEADED //////```"❑ 4.GASOHOL ❑ 99.OTHER <br /> ❑ 3.CHEMICAL PRODUCT COMMON NAME <br /> ❑ (from Hazardous Materials InventO1y page) 441CAS#(from Hazardous Materials Inventory page)) 442 <br /> 4.HAZARDOUS WASTE <br /> (Includes Used Oil) <br /> ❑ 95.UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN <br /> ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER <br /> TANK MATERIAL-primary tank ❑ 1.BARE STEEL ® FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 <br /> (Check oncitcmonly) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL <br /> REINFORCED PLASTIC(FRP) ❑ 99.OTHER <br /> TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ® 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 <br /> (Check one itcmonly) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL <br /> REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER <br /> ❑ 5.CONCRETE <br /> TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING <br /> (Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER <br /> (For local use only) <br /> OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC95 UNKNOWN 448 DATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE PROTECTION ❑ <br /> (Check one item only) ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER <br /> ❑ 2 SACRIFICIAL ANODE (For local use only) <br /> SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> I SPILL CONTAINMENT K <br /> (Check all that apply) ❑ 1 ALARM 3 FILL TUBE SHUT OFF VAL` <br /> 2DROP TUBE ❑ 2BALL 4EXEMPT <br /> 3 STRIKER PLATE FLOAT <br /> IV.TANK LEAK DETECTION(A description of the monitoring program shall be subutitted to the local agency.) <br /> IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one it-only) <br /> ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING <br /> (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> 2� 0.00 gallons ❑Yes E] No <br /> UPCF(12/99 revised) <br />