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�IFIED PROGRAM CONSOLIDATED FV TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page_of_ TYPE OF ACTION [:11 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ID 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE (Check one Item only) ❑ 3 RENEWAL PERMIT (Spedfy reason-for local use only) (Specify reason-for ton430t use only) ❑ 8 TANK REMOVED 1 BUSINESS NAME(Somas FACILITY NAME or DBA-Doing Business As) FACILITY ID: 3 7-Eleven#14117 431 LOCATION WITHIN SITE(Optonal) 2725 CountryCIUb Dr., Stockton, CA 1.TANK DESCRIPTION (A scaled plOtplan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK El Yes ® No 434 1 Total Containment If'Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1998 10,000 ADDITIONAL DESCRIPTION(For local use onry) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL [Ila, REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (If marked complete Petroleum Type) 011b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL [12. NON-FUEL PETROLEUM [31c. MIDGRADE UNLEADED ❑4. GASOHOL [199,OTHER 03. CHEMICAL PRODUCT COMMON NAME (from HareNous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Gasoline (Includes Used Oil) ❑95.UNKNOWN - 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 [14. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank ®1. BARE STEEL 3. FIBERGLASS/PLASTIC 05. CONCRETE 095. UNKNOWN 444 (Check one Item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secondary lank ❑1. BARE STEEL F33. FIBERGLASS/PLASTIC ❑5. CONCRETE [195. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ®4.STEEL CLAD W/FIBERGLASS ❑S. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE [110.COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING C]5.GLASS LINING ❑95.UNKNOWN 446 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (For local use only) (Check one Item only) 44e DATE INSTALLED 449 OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one Item only) ❑2 SACRIFICIAL ANODE (Foruse only) YPE(lora)use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLALL ED 452 SPILL AND OVERFILL YEAR INSTALLED 450 T (Check all ®1 SPILL CONTAINMENT 1998 ®1 ALARM ®3 FILL TUBE SHUT OFF VALVE that apply) ®2 DROP TUBE 1998 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 1998 IV.TANK LEAK DETECTION(A desaipt)on wine monitoring program shall be submitted to the local agency,) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER [:13 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE 455 TANK FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED(YR/MO/DAV) REMAINING gallons ❑Yes ❑ No UPCF (1/99 revised) Formerly SWRCB Form B