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IFIED PROGRAM CONSOLIDATED FOR I ,Z 07TANK: TA0160005 PR#: PRO231600 UNDERGROUND STORAGE TANKS - TANK PAGE IFAC q FAC", FA000NS7 '� U l (two pages per tank) Page 4 of 7 TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check orth•item only) ❑ 7 PERMANENTLY CLOSED ON SITE F] 3 RENEWAL PERMIT (Speciryrcaran-forlocalweonly) (spociiyreason-forlocaluseonly) [j 8 TANK REMOVED 'fait BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As FACILITY ID: PR it LATHROP GAS&FOOD MART* T FA0000957 PR0231600 LOCATION WITHIN SITE(optional) 14800 S HWY 99,MANTECA 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#: 5 439 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes []No 434 TA0160005 OWENS CORNING lf"Yes",wmpktcompageforcwbwmp ml, DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 43f, NUMBER OF COMPARTMENTS 417 111/1989 12:00:OOAM 10,000 ADDITIONAL DESCRIPTION(For localinc only) 434 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® i.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.!ET FUEL (Ifnsarkedwmp)ete Petroleum Type) ❑ Ib PREMIUM UNLEADED ® 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ I c.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Haaurdous Materials invent.,pagcl 441 CAS#(from Hazardous Ma[crials Inrxntoey page) 442 ❑ 4.HAZARDOUS WASTE (lmludes Used oil) ❑ 95.UNKNOWN [H.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3 SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) 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 ooc It=only) ❑ 2 STAINLESS STEEL ❑ STEEL CLAD WIFIBERGLASS ❑ 8 FRP COMPTIBLE Wf I00%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ I BARE STEEL Q 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check one itrnn only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD WtRBERGLASS ❑ S.FRP COMPTIBLE WA 00%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5_CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 441 OR COATING (Clunk,.a item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED ❑ 94.OTHER (Far local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT E]99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE {Forlocal use only) SPILL AND OVERFILL YEAR INSTALLE45a TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ® l SPILL CONTAINMENT 2,003.00 OPW ❑ I ALARM 2,003.00 ❑ 3 FILL TUBE SHUT OFF VAL,2,003.00 ® 2 DROPTUBE 2,003.00 OPW ❑ 2 BALL ❑ 4 EXEMPT ® 3 STRIKER PLATE 2,003.00 W/MAGNET FLOAT W.TANK LEAK DETECTION(A deseriptionof the monitoring program shall be submiaad to the local agency.) IF SINGLE WALL TANK(Check as that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) {Check we nen'only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) []6 VADOSE ZONE ❑ 1 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 ❑ 99 OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE[N PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAIN]NG 436 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12199 revised)