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.- ,- U NIFIED PROGRAM CONSOLIDATED FORM TANK. TA0108106 �& P Q� PR#t PR0231084 UNDERGROUND STORAGE TANKS -TANK PA 1 FAC#t FA0006447 (two pages per tank) Page 4 of 7 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑6 TEMPORARY SITE CLOSURE tChctk only item only) �, ,rn mY Fs `C.,a ?."�s "" " r,-M9 i�: ❑ 7 PERMANENTLY CLOSED ON SITE a ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 .tea � a , z BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business Art FACILITY ID: PR#: 1 SHELL FOOD MART* 3 FA0006447 PR0231084 LOCATION WITHIN SITE(optiaui) 2320 N EL DORADO ST,STOCKTON �S"Zpt( 431 PHONE Zdq 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#: 6 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes �(No 434 UTA0108106 X0 0s If"Yes".h:ompkte one page for each compartment. 1�+ DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 19 9 D 12,000 j ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS �,( TANK USE 439 PETROLEUM TYPE 440 W 1.MOTOR VEHICLE FUEL la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (I(IfmarkedcompletePetroleumType) Qq.Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM T❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Imentorypage) 441 CAS#(from Hazardous Materials Imemory page) 442 ❑ 4.HAZARDOUS WASTE (Ineludu Used Oil) ❑95.UNKNOWN 111.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (F;Md.one itemonly) 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) ❑ 2.STAINLESS STEEL ❑STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100°/METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL 3.FIBERGLASS I PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Chmk one itern W10 ❑ 2.STAIN LESS STEEL �4.STEEL CLADW/FIBERGLASS ❑ 8.FRP COMPTIBLEW/IWI METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING E]❑ 1�y 6 UNLINED 99-OTHER m (Check one iteonly) ❑ 2 ALKYD LINING 4 PHENOLIC LINING !� (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC 1f3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL( YEAR INSTALLE450 TYPE(local useonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chock all that applyt 1 SPILL CONTAINMENT I q 9 a V 1 ALARM 1 1 Q 1 f 'Z3 FILL TUBE SHUT OFF VAL`1?I6 0 �[ 2 DROP TUBE i 4 g o ❑ 2 BALL ❑4 EXEMPT 3 STRIKER PLATE FLOAT M.TANK LEAK DETECTION(.A descrquion of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Chale all that apply) 453 1F DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Chad one item only) ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER K2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ "OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING s56 TANK FILLED WITH INERT MATERIAL'' 457 ❑Yes E] No UPCF(12/99 revised)