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UNIFIED PROGRAM CONSOLIDATED FORM TANK: TA0506493 PR#: PRO231057 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC IN: FA0003720 (two pages per tank) TYPE OF ACTION Page 2 of 7 (CheckaNv nen wy) ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT m(�� ❑STANK REMOVED 430 BUSINESS NAME(Semem FACILITY NAME«DBA-Doing Bus.As) FACILITY ID: PR#: I CHEVRON#92033• 3 FA0003720 PR0231057 LOCATION WITHIN SITE(opri«w) 508 W CHARTER WAY,STOCKTON 431 PHONE L 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 ID# Tank#: 8 411 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes No 434 TA0506493 PLASTEEL I("Ya",mmpleemepege f«eeexe«np.�wmt. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 434 NUMBER OF COMPARTMENTS 437 2/10/1997 12:00:0 12,000 ADDITIONAL DESCRIPTION(F«1«el nseony> 439 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ❑ Is.REGULAR UNLEADED �❑) 2.LEADED ❑ 5.JET FUEL (lfinekedcanphw Pcodeen Type) p0 3.DIESEL ❑6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑ 4.GASOHOL ❑99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(I Ha:edcus Mulsamb Invrn69y page) 441 CAS#(Lam Hewdwe Meienele lnvenwy page) 442 ❑4.HAZARDOUS WASTE (Inemdee Uad a0 ❑95.UNKNOWN M.TANK CONSTRUCTION TYPE OFTANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check...oaly) 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 (Check one imn oay) ❑2.STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check one hum a159 ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE WIMP/.METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ ].RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED "7 OR COATING (Chak ec iters owy) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ❑99.OTHER (Fa IaJ uuaNy) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check moI.my) ❑ 91MPRESSED CURRENT ❑99 OTHER ❑ 2SACRIFICIAL ANODE (F«mW asewy) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(Icmluscoay) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 �IQII1 SPILL CONTAINMENT �= 20041�� OT O�V•V/ 26OL4 (CTwckell Char apply) pi ❑ (ALARM _X3 ELL TUBE SHUT OFF VAL` 2 DROP TUBE K 1 ❑ 2 BALL ❑4 EXEMPT ❑ 3STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d ripum ofine eonamngpmgmm shall x suhmiuw to me I«al agaey) IF SINGLE WALL TANK(Chak all Net apply.) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) (Check oa lmm only) ❑ 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 ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER 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)