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w 0NIFIED PROGRAM CONSOLIDATED FORIS TANK: TA0152203 v PR#: PR0231522 UNDERGROUND STORAGE TANKS - WK PAE 1 FAC#: FA0004051 12d(L- (two pages per tank) Page 2 of 3 TYPE OF ACTION (Check only item only) ❑ I NEW SITE PERMIT E] E]4 AMENDED PERMIT 5 CHANGE OF INFORMATION 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE {Spe/i i�Yis pWtlstyl` (5 tmaoo-Paewww000l3) ❑ 3 RENEWAL PERMIT ( ❑8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: 1 UNITED PARCEL SERVICE STKN/LOD 3 FA0004051 PR0231522 LOCATION WITHIN SITE(optional) 1532 N BROADWAY AVE,STOCKTON 431 PHONE 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#: 3 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes [:]No 434 TA0152203 OWENS CORNING If"Ya",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 11/15/1991 12:00:OOAM 10,000 ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439 PE OLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL I a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (If marked complete Petroleum Type) e�c,,,�,,rr,,, ❑ Ib.PREMIUM UNLEADED X3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM [jIc.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 E] 4.HAZARDOUS WASTE � (f,,, � (Includes Used Oil) 1 \ ' AK✓L // ❑ 95.UNKNOWN 11rrJJ ::JJ L/ III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item 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 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 ❑ I.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) ❑ 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 (Check one item only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ❑99.OTHER (For lural use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC 449 PROTECTION IF APPLICABLE PROTECTION ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED E]4 IMPRESSED CURRENT E]99 OTHER (Chock are item only) ❑2 SACRIFICIAL ANODEFIBERGLASS (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that appy) ® I SPILL CONTAINMENT ® I ALARM ❑ 3 FILL TUBE SHUT OFF VAL% Q 2 DROP TUBE ® 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Cbmk one item only) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑3 MANUAL MONITORING ❑99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 7455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)