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COMPLIANCE INFO_1988-2004
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2300 - Underground Storage Tank Program
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PR0232355
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COMPLIANCE INFO_1988-2004
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Last modified
11/4/2022 10:12:50 AM
Creation date
6/23/2020 6:55:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1988-2004
RECORD_ID
PR0232355
PE
2361
FACILITY_ID
FA0000591
FACILITY_NAME
QUIK STOP MARKET #2152
STREET_NUMBER
1721
Direction
S
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
Zip
95240
APN
062-060-48
CURRENT_STATUS
01
SITE_LOCATION
1721 S CHEROKEE LN # 1
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
Supplemental fields
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\MIGRATIONS\UST\UST_2361_PR0232355_1721 S CHEROKEE_1988-2004.tif
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EHD - Public
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C 1, 11 v'- <br /> IFIED PROGRAM CONSOLIDATED FORM TANK: TA0235502 <br /> r Vf- PR#: PR0232355 <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0000591 <br /> (two pages per tank) <br /> TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT5 CHANGE OF INFORMATION 6 TEMPORARY SITE CLOSURE Page 4 of 7 <br /> (Check only item only) ❑ ❑ <br /> 64 r4xl�s�ti pk.'IEx' --9x;. <br /> ,�,i�` -•' � � - ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT <br /> E]8 TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: 1 <br /> QUIK STOP MARKETS INC#1152 3 FA0000591 PR0232355 <br /> LOCATION WITHIN SITE(Optional) 1721 S CHEROKEE LN 1,LODI q 1� 431 <br /> PHONE,Z D 7-..3 C ry'- 7.3 7S" <br /> I.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#: 2 432 TANK <br /> ��/MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ErNo 434 <br /> XTA0235502 fi dC x t S If"Yes",complete one page for each compartment <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> qd'8 t) CA'jtliJJ.F 10 000 2 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> II.TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ® 1.MOTOR VEHICLE FUEL evva.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL <br /> (If marked complete Petroleum Type) <br /> ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL <br /> ❑ 2.NON-FUEL PETROLEUM 7Ic MIDGRADE UNLEADED <br /> ❑ 4.GASOHOL ❑ 99.OTHER <br /> ❑ 3.CHEMICAL PRODUCT <br /> COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 <br /> ❑4.HAZARDOUS WASTE <br /> (Includes Used Oil) ��� L - C�9�d L � <br /> ❑ 95.UNKNOWN <br /> O! V 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 ❑ L BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 <br /> (Check one item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS Q 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 item only) ❑ 2.STAINLESS STEEL E] Lh 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 ❑ L RUBBER LINED <br /> OR COATING ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 <br /> (Check one item only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING UNLINED ❑ 99.OTHER <br /> (For local use only) <br /> OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 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(I-I use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Check all that apply) 101"SPILL CONTAINMENT !FY7 <br /> F]!'7,V7 c� I ALARM &0'3 FILL TUBE SHUT OFF VAL` / <br /> 91,DROP TUBE <br /> L ❑ 2 BALL ❑4 EXEMPT <br /> ['3 STRIKER PLATE i 99g FLOAT <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 454 <br /> ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) <br /> ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER 912 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING E]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 /> ❑Yes ❑ No <br /> UPCF(12/99 revised) <br />
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