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t FIED PROGRAM CONSOLIDATED F019 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (hoop )o per�) Page_of TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑O 7TEMPORARY PERMANENTLY CLOSED ON SITE (Check one item only) 430 ❑ 3 RENEWAL PERMIT (Specify reason-tar local use only) (Specify reason-for local use only) ❑ STANK REMOVED i BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: ^ n 7-Eleven#14117 a3, LOCATION WITHIN SITE(Optional) 2725 Count Club Dr., Stockton, CA I.TANK DESCRIPTION (A scaled plot plan With ME location ci fhe U n Sy WT including buildings and landmarks shall be submitted to the local a enc TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 Total Containment If"Yes",complete one page for each compartment. D E INSTALLED(Y R/M0) 435 TANK CAPACITY IN GALLONS 43e NUMBER OF COMPARTMENTS 437 4/1998 10,000 438 ADDITIONAL DESCRIPTION(Forlocal use only) Il.TANK.CONTENTS 440 E-P K USE 439 PETROLEUM TYEEAE OR VEHICLE FUEL ❑1a. REGULAR ❑2. LEADED ❑5. JET FUELmplete Petroleum Type) ®1b. PREMIUM 3. DIESEL ❑6. AVIATION FUEL-FUEL PETROLEUM ❑1c. MIDGRADE ❑4. GASOHOL ❑99.OTHER_ 4a2N p g ) 441 CAS#(from Hazardous Matenals Inventory page)MICAL PRODUCT COMMONNAMEenals Invento a eARDOUS WASTE Gasolines Used Oil)KNOWN NK 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 El 95. UNKNOWN ®2. DOUBLE WALL [14. SIGNLE WALL IN VAULT [199. OTHER_ 444 TANK MATERIAL-primary lank ®1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE [195. UNKNOWN (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secontlary lank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 ETANK e it, only) ❑2. STAINLESS STEEL [14.STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ®99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TERIOR LINING ❑1.RUBBER LINED ❑3.EPDXYLINING ❑5.GLASS LINING ❑95.UNKNOWN446DATEINSTALLED 447 ATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6UNLINED ❑99 OTHER (For lural use only) ne 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 (For local use only) (Check one Item only) ❑2SACRIFICIAL ANODE 452 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EOUIPMENT:YF- . I INSTALLED (Check all ®1 SPILL CONTAINMENT 1998 0 ALARM ❑3 FILLTUBE SHUT OFFVALVE that apply) ®2DROP TUBE 1998 ®2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 1998 _ IV.TANK LEAK DETECTION(A description of the mondonng program shalt be submitted to the.local agency.) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 IF SINGLE WALL TANK(Check all that apply) (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 ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER _ IV.TANK CLOSURE INFO RMATION.IPERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE 455 457 ESTIMATED DATE LAST USED(YR/MO/DAY) TANK FILLED WITH INERT MATERIAL? REMAINING gallons ❑Yes ❑ No UPCF (1/99 revised) Formerly SWRCB FoOB