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COMPLIANCE INFO_2005-2009
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2300 - Underground Storage Tank Program
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PR0232355
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COMPLIANCE INFO_2005-2009
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Last modified
2/7/2024 4:16:46 PM
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
2005-2009
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
FilePath
\MIGRATIONS\UST\UST_2361_PR0232355_1721 S CHEROKEE_2005-2009.tif
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EHD - Public
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z -r <br /> IED PROGRAM CONSOLIDATED FC I cl <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 )()1 <br /> (two pager tank) <br /> Page Z,of <br /> TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID: I I I I I I I I I I I I +-L <br /> Quik Stop Market#152 <br /> LOCATION WITHIN SITE(Optional) 431 <br /> 1.TANK DESCRIPTION (A scaled plot plan with the location of the LIST system including buildings and landmarks shall be submitted to the local <br /> agency.) <br /> TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 <br /> 1 T Xerxes If"Yes",complete one page for each compartment. <br /> DATE INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> (YEAR/MO) <br /> 1988/December 10,000 1 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> IL TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ®1. MOTOR VEHICLE FUEL ® 1a. REGULAR UNLEADED ❑2. LEADED [:15. JET FUEL <br /> (If marked complete Petroleum Type) ❑1 b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL <br /> ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ <br /> ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 <br /> ❑4. HAZARDOUS WASTE Unleaded Gasoline (Regular, 87 Octane) <br /> (Includes Used Oil) <br /> ❑95.UNKNOWN <br /> 111. TANKCONSTRUCTION <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. SIGNLE WALL IN VAULT ❑99. OTHER <br /> TANK MATERIAL-primary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 <br /> (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ®8. FRP COMPATIBLE W/ ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) 100%METHANOL <br /> TANK MATERIAL-secondarytank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC [15. CONCRETE [195. UNKNOWN 445 <br /> (Check one item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ®8. FRP COMPATIBLE ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) W/100%METHANOL <br /> ❑5. CONCRETE [110.COATED STEEL <br /> TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER <br /> (Check one item only) (For local use only) <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ®99 OTHER <br /> (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> only) <br /> (Check all ®1 SPILL CONTAINMENT 1989 ❑1 ALARM ISI 3 FILL TUBE SHUT OFF VALVE <br /> that apply) - <br /> ®2 DROP TUBE 1989 ❑2 BALL FLOAT ❑4 EXEMPT <br /> ®3 STRIKER PLATE 1988 <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 /> (Check one item only) <br /> ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> +(SIR) BIENNIAL TANK TESTING ❑99 OTHER - <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 1 TANK FILLED WITH INERT MATERIAL? 457 <br /> REMAINING <br /> UPCF (1/99 revised) Formerly SWRCB Form B <br />
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