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w ;flED PROGRAM CONSOLIDATED FOF TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 8(asJo� (two pages per tank) Page_of TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ e TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ® 3 RENEWAL PERMIT (Speciyreason-forloraluseonly) (Specify reason-for local use only) ❑ STANK REMOVED 430 BUSINESS NAME(Sam w FACILITY NAME or DBA-Doing Businasa As) 3 FACILITY ID: F A 0 0 0 2 4 7 9 t 7-Eleven#17334 LOCATION WITHIN SITE(Optional) a3t 4501 Pershing Ave. Stockton, CA 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# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes ® No 434 1 Total Containment If-Yes Ca Plate one page for each compamnent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 438 NUMBER OF COMPARTMENTS 437 4/1998 10,000 ADDITIONAL DESCRIPTION(For local use only) 438 It.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ®Ia. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If market complete Petroleum Type) 01b. PREMIUM UNLEADED 03. DIESEL ❑e. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑tc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(hom Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Gasoline (Induces Used Oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chlor one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL [34. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank ®1. RARE STEEL 03. FIBERGLASS/PLASTIC 05. CONCRETE 095. UNKNOWN 444 (check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secandaytnk 0 1. BARE STEEL [13. FIBERGLASS/PLASTIC 0 5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ®99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN a46 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®e UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ®1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ®1 SPILL CONTAINMENT that apply) 1998 ® 1 ALARM ❑3 FILLTUBE SHUT OFF VALVE ®2 DROP TUBE 1998 ®2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 1998 IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check al that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑B VADOSE ZONE M 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑e TANK TESTING +(SIR) BIENNIAL TANK TESTING 0 9 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 458 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B