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IFIED PROGRAM CONSOLIDATED FORNO tg I �,{� TANK: TA0515703 "`1�� PR#: PRO521942 UNDERGROUND STORAGE TANKS - TANK PAGE 1 �� FAC#: FAD014921 (two pages per tank) Page 4.f 5 TYPE OF ACTION INEW SITE PERMIT ❑ 4AMENDED PERMIT E:15 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (OaatkaJyitanoM') ❑ [17 PERMANENTLY CLOSED ON SITE 8TANK REMOVED 430 (sPDo fy realm-fa loon wemIy) (Spooryfemon fa lacel uxady) 3 RENEWAL PERMIT ❑ ❑ J BUSINESSNAh4E(Saaca FACRr NA mDBA-Wa gB im Aa) FACILITY ID: PR#: RANCHO SAN MIGUEL MARKET* 3 FA0014921 PRO521942 LOCATION WITHIN SITE(opiimdl 1427 AIRPORT WAY,STOCKTON 431 PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK m# Tank#: 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ®Yes ❑No 434 TA0515703 K&T STEEL v^va^.allnpMe meww ra cecnaaapannrnt. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1/28/2004 12:00:OOAM 5,000 1 2 ADDITIONAL DESCRIPTION(F«I«.l me ori 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 44o ® 1.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑5.JET FUEL (Ifaakalwaploa Pelminvn Tape) ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAW(froa xawaous Materials lacntary page) 441 CAS#(flan xamMau Metaiex lmaeary page) 442 ❑ 4.HAZARDOUS WASTE Imlaha uadoi0 ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CMck are item a*) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN ®2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑99.OTHER TANK MATERIA.-primary tank ❑ I.BARE STEEL ® FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑95.UNKNOWN 444 (Cn k.aarauy) ❑ 2.STAINLESS STEEL ❑ STEEL CLADW/FIBERGLASS ❑ B.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ LBARE STEEL ® 3.FIBERGLASS/PLASTIC ❑5.CONCRETE ❑95.UNKNOWN 445 (Check ane itan adv) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRPCOMPT®LEW/100°/6METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LMING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑5.GLASS LINING E]95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Chak me kw mly) E] 2 ALKYD LINING E]4 PHENOLIC LINING ® 6 UNLINED ❑99.OTHER (Porkcel useaNy) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check a a it.mly) E]4IMPRESSED CURRENT ❑990TEIER (Falialaaaib') ❑ 2SACRIFlCLll.ANODfi SPILLANDOVERFILL YEAR INSTALLE450 TYPE(Imalasconly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 453 (nmkall@aappht ® I SPILL CONTAINMENT 2,004.00 OPW ® IALARM ® 3 FILL TUBE SHUT OFF VAL`2,004.00 ❑X 2 DROPTUBE 2,004.00 OPW ® 2 BALL ❑ 4 EXEMPT X❑ 3STRIKER PLATE 2,004.00 OPW FLOAT IV.TANK LEAK DETECTION(A destromm of Ina maaitadng prasca aball be sobMnM 0 da bon ageaYJ IF SINGLE WALL TANK(Clawk all that appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chat am itea0*) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE 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)BIENNIAL TANK TESTING ❑ 990TRER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)