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0 IFIED PROGRAM CONSOLIDATED FOR P j� TANK: TA0160006 PR#: PR0231600 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#; FA0000957 (two pages per tank) Page 6 of 7 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 5 TEMPORARY SITE CLOSURE (Check only item on),l ❑ 7 PERMANENTLY CLOSED ON SITE (Specify reason-for local the only) (SpaciSw reason-Tor local use only) [jBTANK REMOVED 430 ❑ 3 RENEWAL PERMIT BUSINESS NAME(same as FACILITY NAME or PRA-Doing Rush As) FACILITY ID: PR#: I LATHROP GAS&FOOD MART* 3 FA0000957 PR0231600 LOCATION WITHIN SITE(Opircnal) 14800 S HWY 99,MANTECA 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#: 6 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ❑ND 434 TA0160006 OWENS CORNING If"Y&%completemcpayefarcach wmpartmnL DATE INSTALLED(YEAR/NIO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1/1/1989 12:00:00" 8 000 ADDITIONAL DESCRIPTION(For local osc only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ❑ I a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (If marked complete Pdroleum Type} 19 lb.PREMIUM UNLEADED ,F3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99 OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME ffrour Ha ardrws Materials Imxntory pallcl 441 CAS#(from Hazardous Malcrials Invmtory page) 442 ❑4 HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN IH.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH [] 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 441 (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 M FIBERGLASS/PLASTIC ❑ 5 CONCRETE ❑ 95.UNKNOWN 444 (Chcckome item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W1 I009/6 METHANOL REINFORCED PLASTIC(FRP) ❑ 99,OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑3 FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 441 (Check ane stem only) ❑ 2 STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ® 8.FRPCOMPTIBLE W/IW/o METHANOL REINFORCED PLASTIC(FRP) ❑ W.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 3.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check ore item enly) 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED ❑ 99 OTHER ❑ (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION /Check ane item aril•) ❑ 4 IMPRESSED CURRENT ❑,99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE456 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 45' (Check all that apply) [)� I SPILL CONTAINMENT 2,003.00 OPW [N] 1 ALARM 2,003.00 ® 3 FILL TUBE SHUT OFF VAL,2,003.00 X❑ 2 DROP TUBE 2,003.00 OPW ❑ 2 BALL ❑4 EXEMPT X❑ 3 STRIKER PLATE 2,003.00 W/MAGNET FLOAT IV.TANK LEAK DETECTION;A description of the monitoring pmgam shall he submitted to dee local IF SINGLE WALL TANK(Cheek all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check me item 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 ❑990TRER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 �FILLEDITH INERT MATERIAL? 457 Yes ❑ No UPCF(12/99 revised)