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UNIFIED PROGRAM CONSOLIDATED FORM TANK: TA0506494 PRO: PR0231057 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0003720 (two pages per tank) TYPE OF ACTION Page 4 of 7 (Clink m1y ima my) ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 BUSINESS NAME(Sameas FACILITY NAME or DBA-Dams Bmin«s An FACILITY ID: PR#: 1 CHEVRON#92033• 3 FA0003720 PR0231057 LOCATION WITHIN SITE(opdmn) 508 W CHARTER 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 ID# Tank#: 9 433 TANK MANUFACTURER 499 COMPARTMENTALIZED TANK ❑yes )qNo 434 TA0506494 PLASTEEL 1f-Y"-'oaoP1acmcP.gcfaaa1ccao m«m. DATE INSTALLED(YEAR/MO) 495 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 437 2/10/1997 12:0O:OOAM 12,000 ADDITIONAL DESCRIPTION(For Im.l me mhq 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® a40 I.MOTOR VEHICLE FUEL E] Ia.REGULAR UNLEADED ❑2.LEADED ❑ S.JET FUEL nfro k oaaplac PClralmm T)Pc) lb.PREMIUM UNLEADED 3.DIESEL I"� ❑ ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM99 8E lA fmli1ED ❑4.GASOHOL F-13.CHEMICAL PRODUCT ❑99.OTHER COMMON NAME Oran x..amasMmaiela mse,tmyPar) 441 CAS# ❑4.HAZARDOUS WASTE (I.H. om Maaials msen.page) M2 0«Idm Usd Oia ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chalk ac a.any) EXTERIOR MEMBRANE LINER El 95,UNKNOWN ®2.DOUBLE WALL ❑4.SINGLE WALL M VAULT ❑99.OTHER TANK MATERIAL-primary lank ❑ I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE [195.UNKNOWN 444 (Dh me iter my) ❑Z STAINLESS STEEL ® STEEL CLAD W/FlBERGLASS ❑ 8.FRP COMPTIBLE W/100°/.METHANOL REINFORCED PLASTIC(FAP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check ane a.mry) ❑2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRPCOMPTIBLEW/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ ],RUBBER LINED ❑ 3.EPDXY LINING 447 OR COATING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED (Ch one ion only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ❑99.OTHER IF«last memN) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Ch .ima adv) ❑4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 25ACRIFICW.ANODE (F«bcil use my) SPILL AND OVERFILL YEAR MSTA�LL4�E45�0 TYPE0.lucmly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 4 452 (CMckilldsawb) •� I SPILL CONTAINMENT }9w._oll 2A Opk / ElIALAAM I�FILLTUBE SHUT OFF YAL` 2W 2DROP TUBE Aad/ r Vv ❑ 3 STRIKER PLATEk ❑ 2 BALL ❑4 EXEMPT FLOAT IV.TANK LEAK DETECTION(A dmcoptlanof as m..itaing pmgrmn shall d•abmiud to Ina Imm.gcm J IF SINGLE WALL TANK(Ch«k 41 not appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (D=k me a.mly) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL M VAULT ONLY) ❑ 3CONTIN000S ATG ❑ 7GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE F IMATED 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)