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FIED PROGRAM CONSOLIDATED FO TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page_of CLOSURE CLOSUR TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑O 7 TEMPPERMPERMORARY SITE TLY TLY CLOSED ON SITE (Check one item only) 439 ❑ 3 RENEWAL PERMIT (Specify reason-for tocol use only) (Spedfy reason-for torsi use only) ❑ 6 TANK REMOVED 1 FACILITY ID: BUSINESS NAME(Sam as FACILITY NAME or DBA-Doing Business As) 3 7-Eleven#14117 431 LOCATION WITHIN SITE(Optional) 2725 CountryClub Dr., Stockton, CA L.TANK DE5CRIPTION (A scaled plot plan withthe location df the UST system inGuding buildings and landmarks shall be submittedt0 the local agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 2 Total Containment ;NUZMBER ',woplete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 43s OF COMPARTMENTS 437 4/1998 10,000 43B ADDITIONAL DESCRIPTION(Forlowl useonly) II.TANK CONTENTS 440 TANK USE 439 PETROLEUM TYPE ®1. MOTOR VEHICLE FUEL ® Is, REGULAR UNLEADED ❑2. LEADED ❑ . JET FUEL (if marked complete Petroleum Type) ❑11b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c, MIDGRADE UNLEADED [14. GASOHOL [199.OTHER_ 442 [13. CHEMICAL PRODUCT COMMON NAME (from Hazardous Meledals Inventory page) 441 CAS#(from Hazardous Materials Imrantory,Page) ❑4. HAZARDOUS WASTE Gasoline (Includes Used 019 ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH [15, SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ®2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER_ 4a4 TANK MATERIAL-primary tank ®1. BARE STEEL ❑3. FIBERGLASS/PLASTIC [15. CONCRETE [195. UNKNOWN (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/ [199,OTHER REINFORCED PLASTIC(FRP) 100%.METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE [3 95. UNKNOWN pir 445 (Check one item only) 2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS [38. FRP COMPATIBLE ®99.OTHER ❑ REINFORCED PLASTIC(FRP) W1100%METHANOL [15. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING [:]1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING [395.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 19 6 UNLINED ❑99 OTHER (Forlocal use only) (Check we item only) 449 DATEINSTALLED 449 OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (For local use only) (Check one Item only) ❑2 SACRIFICIAL ANODE 452 45o TYPE local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED SPILL AND OVERFILL YEAR INSTALLED ( (Check all ®1 SPILL CONTAINMENT 1998 El ALARM ®3 FILLTUBE SHUT OFFVALVE that apply) ❑2 BALL FLOAT ❑4 EXEMPT ®2DROP TUBE 1998 ®3 STRIKER PLATE 1998 IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the lows agency.) 454 IF SINGLE WALL TANK(Check all that app;TANK 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(Ml ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING [:13 CONTINUOUS ATG ❑7 GROUNDWATER 113 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCI ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER _ IV. 'CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE 45s as7 TANK FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YRIMO/DAY) REMAINING gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B