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'1NIFIED PROGRAM CONSOLIDATED FOI TANK: TA0103603 PR at: PRO231036 UNDMGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0003761 (Iwo pages per tank) Page 2 of3 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑4"ENDED PERMIT ❑ 5CHANGE OF INFORMATION ❑ 6TEMPORARYSITE CLOSURE (C3ed any'"ea,aay) ❑ 7 PERMANENTLY CLOSED ON SITE ys4uou- rbW.0 1 (Spsitytet®-6 .. El RENEWAL PERMIT ®F§y ❑STANK REMOVED 4" BUSINESS NAME ISamc as FACILITY NAME aDBA-Doing Bmi11w As) FACILITYID: PR#: ST JOSEPHS HOSPITAL I 3 FA0003761 PR0231036 LOCATION WITHIN SITE(opsiuu0 1800 N CALIFORNIA ST,STOCKTON 431 PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subttutted to the local agency.) TANK IDN Tank#: 3 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ®Yes ❑No 434 TA0103603/MLOCMI�rs Ir-Yo.emykss orcpager«n�mam�s DATE INSTALLED(YEAR/MO) 43s TANK CAPACITY IN GALLON 436 NUMBER OF COMPARTMENTS 433 \CkR'a. 20,000 ADDITIONAL DESCRIPTION(Fm wu1 use my) 439 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 449 ® L MOTOR VEHICLE FUEL ❑ Ia.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL nfmmkedcomplem PeVolemn Type) ❑ Ib.PREMIUMUNLEADED ® 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADEUNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME loam Haasmm Madals lmmtmyw&) a41 CAS#(fmm Hated Mauraalmauosypage) M2 ❑ 4.HAZARDOUS WASTE (IrcIWe UW Oil) ❑95.UNKNOWN IH.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH E] 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM N3 (Cti�k oM 6an Wr) 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 (C k om iron my) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ IL FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99,OTHER TANKMATERIAL-secondary tank ❑ 1.BARE STEEL 1@ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN As (C6aek om nem only) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/IU0%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED H3 ORCOATING fl 6 k Doe ft.Dory) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED ❑ ".OTHER IFm lonl mealy) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN as DATE INSTALLED H9 PROTECTION IF APPLICABLE PROTECTION (makm Nuns my) ❑ 41MPRESSED CURRENT ❑ 99 OTHER ❑ 25ACRIFICIAL ANODE (F.kvluu Wy) SPILL AND OVERFILL %(:M*, YEAR MSTALLE450 TYPE(Iocmme Wy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 JC kan16styly) ❑ 1 SPILL CONTAINMENT ® 1ALARM ❑ 3 FILL TUBE SHUT OFF VAL` ® 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A damlpdonofdc-issnngpsogram sun x o6mkssd us use 1=1 ag y.) IF SINGLE WALL TANK(CImckan t6a appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ICM1ak as nw Wry) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ® 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑ 3 MANUAL MONITORING (SIR)BIENNIA,TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANKFILLEDWITHINERT MATERIAL? 4n ❑Yes ❑No rj UPCF(12/99 revised) ��-