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UNIFIED PROGRAM CONSOLIDATED FORM TANK: TA0506495 PR#: PR0231057 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC H: FA0003720 (two pages per tank) TYPE OF ACTIONPage 6 of7 hcF oaly aemaNy) ElI NEW SITE PERMIT ❑4 AMENDED PERMIT X5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE [:17 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT ❑STANK REMOVED 430 BUSINESS NAME(Sameas FACILITY NAME«DBA-Mang aui«as As) FACILITY ID: P3#: 1 CHEVRON#92033* 3 FA0003720 PR02t057 LOCATION WITHIN SITE(Optional) 508 W CHARTER WAY,STOCKTON 431 PHONE 1.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#: 10 432 TANK MANUFACTURER 033 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0506495 PLASTEEL Ir^vo �pkte«mp.ger e.en aomp.runrnl DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 437 2/10/1997 12:00:OOAM 12,000 ADDITIONAL DESCRIPTION(F«Ionai asa onb) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ® la REGULAR UNLEADED ❑ 2.LEADED ❑S.JET FUEL 0fmakwuvnplaa Pcaolcum T>Pc) ❑ I b.PREMRJMUNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(sou Ha.«loo,Maunuo lnvaw5,psap) 441 CAS4(from Hamrdaas Matcrials lmrnmy page) 492 ❑4.HAZARDOUS WASTE (I«kalas Usd Oil) ❑95.UNKNOWN HL TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chale ane han only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN M 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary lank ❑ I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 444 (Ch J:arei as only) ❑ 2.STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTBLE W/IW%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL.secondary tank ❑ 1,BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN 445 (Chad:arc ium only) ❑2.STAINLESS STEEL ❑4.STEEL CLAD WNIBERGLASS ❑ 8.FRP COMPTIBLE W/100 METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ OR COATING I.RUBBER LINED [j3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 (Chakaaiatupoly) ❑ 2ALKYD LINING ❑ 4PHENOLIC LINING ❑ 6UNLINED ❑ 99.OTHER (F«but uaoNy) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Chalk me imn only) E] 4 IMPRESSED CURRENT ❑990THER F1 2SACRIFICIAL ANODE (F«bael me oab) SPILL AND OVERFILL YEARINSTALLE450 TYPE(bcaluast 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 Tri CONTAINMENT �0 U�-/I SPILL CONTAINME2401 (Ch«k dl Ibn appl.) pEln� / 1 ALARM K3 FILL TUBE SHUT OFF VOL` 19 2 DROP TUBE O r W ❑ 2 BALL ❑ 4 EXEMPT ❑ 3STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d«miption ufrhs m«tit«in8 na,ao shall x:abmntm tome 1=1 aycaa,.) IF SINGLE WALL TANK(Chakall Nat wpb') 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) (Chakonssuntoly) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑3 MANUAL MONITORING F1 99 V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)