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COMPLIANCE INFO_1999-2003
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2300 - Underground Storage Tank Program
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PR0231126
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COMPLIANCE INFO_1999-2003
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Last modified
6/30/2020 10:41:00 AM
Creation date
6/23/2020 6:44:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1999-2003
RECORD_ID
PR0231126
PE
2361
FACILITY_ID
FA0001570
FACILITY_NAME
UNITED # 5447
STREET_NUMBER
1469
Direction
E
STREET_NAME
HAMMER
STREET_TYPE
LN
City
STOCKTON
Zip
95210
APN
08818030
CURRENT_STATUS
01
SITE_LOCATION
1469 E HAMMER LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\UST\UST_2361_PR0231126_1469 E HAMMER_1999-2003.tif
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EHD - Public
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UNIFIED PROGRAM CONSOLIDATED FORM /(Ilp/ L <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> (t"pages per tank) <br /> Page_of <br /> TYPE OF ACTION ❑1. NEW SITE PERMIT [:]4. AMENDED PERMIT ®5. CHANGE OF INFORMATION) [:16. TEMPORARY SITE CLOSURE <br /> (Check one item only) []7. PERMANENTLY CLOSED ON SITE <br /> [:13. RENEWAL PERMIT <br /> (Specify reason-for local use only) (Specify change-for Iotal use only) [:18. TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# I <br /> Circle K Stores, Inc. #2705447/05447 <br /> LOCATION WITHIN SITE(Optional) 431 <br /> 1.TANK DESCRIPTION (A scaled plot plan with the location ojthe UST system including buildings and landmarks shall be submitted to the local agency.) <br /> TANK ID# Vi <br /> ^ 432 TANK FACTURER ( 433 COMPARTMENTALIZED TANK ❑ Yes No 434 <br /> T!1 D�D 7.1 5 0 p J` \ If, Yesl2.,complete one page for each co artment � <br /> DATE INSTALL(Y$A/R/1MO) [ O l/ 435 TANK CAPf♦,GIT/Yw/`16LLLOONS 436 NUMBER OF COMPARTMENTS 437 <br /> ry I U t 0 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> 11.TANK CONTENTS <br /> TANK USE 439 <br /> MOTOR VEHICLE FUEL ❑la. REGULAR E 440 <br /> LAR UN EADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (/jmnrked,complete Petroleum Type) ❑Ib. PREMIUM UNLEADED 3. DIESEL ❑ 6. AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED 4. GASOHOL ❑99. OTHER <br /> ❑3. CHEMICAL PRODUCT <br /> ❑ 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 <br /> Used Oil) <br /> ❑95. XERXES <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑l. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Check one item only) <br /> 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. XERXES <br /> ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER <br /> TANK MATERIAL-primary tank ❑1 BARE STEEL3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. XERXES 444 <br /> (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER _ <br /> REINFORCED PLASTIC FRP <br /> TANK MATERIAL-secondary tank ❑1 BARE STEEL 3. FIBERGLASS/PLASTIC ❑8. FRP COMPATIBLE W/100%METHANOL ❑95. XERXES 445 <br /> (Check one item only) ❑2 STAINLESS STEEL 1:14. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODIBLE JACKET ❑99. OTHER _ <br /> REINFORCED PLASTIC(FRP) E110 COATED STEEL <br /> 05. CONCRETE <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑3. EPDXY LINING ❑5. GLASS LINING ❑95. XERXES 446 DATE INSTALLED 447 <br /> OR COATING [:11 ALKYD LINING E]4. PHENOLIC LINING `fa- UNLINED ❑99. OTHER <br /> Check one item only) �• For local use onl <br /> OTHER CORROSION ❑1. MANUFACTURED 3. FIBERGLASS REINFORCED PLASTIC [:195. XERXES 448 DATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE CATHODIC <br /> 4. IMPRESSED CURRENT ❑99. OTHER <br /> PROTECTION <br /> (Check one item only) (For local use only) <br /> [12. SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INS us <br /> 450 TYPE(For local e only) 451 OVERFILL PROTECTION EQUI E T:YEAR INSTALLED 52 <br /> 1. SPILL CONTAINMENT [11. ALARM FILL TUBE SHUT OFF VALVE <br /> (Check all that apply) <br /> DROP TUBE [:]2. BALL FLOAT [:]4. EXEMPT <br /> 3. STRIKER PLATE <br /> IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) <br /> IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 <br /> ❑I, VISUAL(EXPOSED PORTION ONLY) ❑5. MANUAL TANK GAUGING(MTG) [-]I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2. AUTOMATIC TANK GAUGING(ATG) 1--16. VADOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3. CONTINUOUS ATG ❑7. GROUNDWATER ❑3. MANUAL MONITORING <br /> ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR)I ❑8. TANK TESTING <br /> 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 /> gallons Yes No <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />
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