COMPLIANCE INFO_2001-2011 - Laserfiche WebLink

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-fit UNIFIED PROGRAM CONSOLIDATED FORM TANK: TA0108107 PR#: PRO231084 UNDERGROUND STORAGE TANKS -]nGE 1 FAC#: FAM06447 7 (two pages per tank) Page 6 of 7 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑6 TEMPORARY SITE CLOSURE (Check only itan only) a r fieg 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT & ;..� ��'�� f ❑8 TANK REMOVED 470 J-71 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Rosiness As) FACILITY ID: PR#: I SHELL FOOD MART* 3 FA0006447 PR0231084 LOCATION WITHIN SITE(Optional) 2320 N EL DORADO ST,STOCKTON C 5"70 V !! 471 PHONE Z Q ! • Y 1 I 1.TANK DESCRIPTION(A scaled plot plan with the location ofthe UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# Tank#: 7 472 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK D Yes JXNo 474 TA0108107 )(A-4:R,k 6 s If"Yes",conylete one page for each cornpartmnu. DATE INSTALLED(YEAR/MO) 475 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 477 19 9 0 12000 / ADDITIONAL DESCRIPTION(For localusemdy) 438 IL TANK CONTENTS TANK USE 419 PETROLEUM TYPE S40 1KI.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL (Itnarked compkte Parolean Type) ❑ Ib.PREMIUM UNLEADED ❑3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM c.MIDGRADE UNLEADED E]4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT yam, COMMON NAME(from Hanrdow Materials invent y page) 441 CAS#(from Hz.a dcus Materials Inventory page) 442 ❑4.HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one itan 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 ane it-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/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Check one item only) ❑ 2.STAINLESS STEEL �4.STEEL CLAD W/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) D 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING D 1.RUBBER LINED ❑3.EPDXY LINING ❑ 5.GLASS LINING ❑95.INKNOWN 446 DATE INSTALLED 447 OR COATING (Cbcck arc item only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING X6 UNLINED ❑99.OTHER _ (For local use only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED at9 PROTECTION IF APPLICABLE PROTECTION (Check arc item only) ❑4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local usconly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 I SPILL CONTAINMENT t 0 �1 1 5 01790 (Check all that apply) Cf'I ALARM FILL TUBE SHUT OFF VAL' 2 DROP TUBE0 E] 2 BALL 4 EXEMPT 3 STRIKER PLATE i g 9 D FLOAT IV.TANK LEAK DETECTION(A dnmption of the tnonitaring 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 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check onc item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER V2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MOiDAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑ Yes ❑No UPCF(12/99 revised)