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FIED PROGRAM CONSOLIDATED FORM (t 1 'T TANK: TA0515657 : PRO518829 UNDERGROUND STORAGE TANKS - TANK PAGE 1 DO FAC#FIR N FA0014175 ([wo pages per tank) TYPE OF ACTION ❑ 1 NEW SITE PERMIT ��('vC (Clerk mtyitem onhl ❑ J:\\IlNDED PFR�II'I 1 CHANGE OF INFORMATION Pageio0 ❑ 6 TEMPORARY SITE CLOSURE ❑ 3 RENEWAL PERMIT (Ser (> �r locni nsc only) 6p«5 maso6.f Io BUSINESS NAME(S--es FACILITY NAME or DBA-Wng Bmmcss As) o FACILITY ID. ❑STANK REMOVED 430 WOMENS CENTER PR't LOCATION WITHIN SITE(Dpuorop 620 N SAN JOAQUIN STs STOCKTON FA0014175 PR0518829 4311 I.TANK DESCRIPTION(A scaled plot plan with the location ofthe UST system includingbuildings and landmarks shall be sO NE 431 MANUFACTURER ubmitted to the local agency.) TANK HJ# Tank N: 1 TANK 433 COMPARTMENTALIZED TANK TA0515657 [:)Yes E]No 434 DATE INS TALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS If"y-',enellela pnep.p fes-6 comp.I. 436 NUMBER OF COMPARTMENTS ADDITIONAL DESCRIPTION(Fw loin use onn) 500 437 439 TANK USED.TANK CONTENTS 439 PETROLEUM TYPE ❑ I.MOTOR VEHICLE FUEL ❑ is.REGULAR UNLEADED (Ifinerkoi wmplec Pewlcum T1,C) El PREMIUM 2.LEADED ❑ S IET FUEL �0 Ib.PAEMM UNLEADED E];.DIESEL ❑2.NON-FUIECHEMICAL PETROLEUM ❑ I c.MIDGRADE UNLEADED ❑99.OTHER FUEL ❑3.CHEMICAL PRODUCT ❑4.GASOHOL ® 99.OTHER ❑4_HAZARDOUS WASTE COMMON NAME III Humdws Materiels My ntey peg) 4411 CASA(6wn xe„rdo,u MelwiaB mr-rntw.Page) (lneludrs Ueoi Oi0 442 ❑95.UNKNOWN ID.TANK CONSTRUCTION TYPEOFTANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH (Chwk ps,i¢m nnh) EXTERIOR MEMBRANE LINER [-15.SINGLE WALL WITH INTERNAL BLADDER 443 El 95.UNKNOWN ❑ 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑99.OTHER TANK MATERIAL-primary pink ❑ I BARESTEEL ❑ FIBERGLASS/PLASTIC (Clic l,mcisen wily) ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 ❑2.STAINLESSSTEEL ❑ STEEL CLAD WLASTI (FRP) ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) E:1 99,OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑9 (Check os,nuen Onh) UNKNOWN 44i El 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FTBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL THANOL REINFORCED PLASTIC(FRP) ❑ El. 10.COATED STEEL El 99,OTHER 5CONCRETE TANK INTERIOR LINING OR COATING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 (Chckonni¢mmJy) ❑ 2ALKYD LINING ❑ 4 PHENOLIC LINING ❑6IINLINED ❑ 99.OTHER OTHER CORROSION FF-1-.Iuu way) PROTECTION IF APPLICABLE ❑ PROTECTION RING CATHODIC E];FIBERGLASS REINFORCED PLASTIC (Chwk we limn mk) D 9 UNKNOWN 449 DATE INSTALLED qqq [:1 2SACRIFICIAL ANODE ❑4IMPRESSED CURRENT ❑ 990THER SPILL AND OVERFILL CF- YEAR lwal uuom54 YEAR INSTALLE-430 TYPE Rornl an nela) 451 OVERFILL PROTECTION EQUIPMENT: WC kellmaopply) ❑ I SPILL CONTAINMENT Q YEAR INSTALLED 452 ❑ 2 DROP TUBE ❑ 'ALARM ❑3 FILL TUBE SHUT OFF VAL' ❑ 3 STRIKER PLATE ❑ 2 BALL ❑4 EXEMPT FLOAT N.TANK LEAK DETECTION(A desertion of the mndtnnnm 9 pgmn shill y,ln,mmea w an low ag .:)ue IF SINGLE WALL TANK(Click d1 lhw III 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) (Clerk a4C I.only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE 1:11 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑4 STATISTICAL INVENTORY RECONCILIATION El 2 CONTINUOUS INTERSTITIAL MONITORING(SIR)BIENNIAL TANK TESTING ❑9 TANK TESTING ❑ 99 OTHER ❑3MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 1/1/1986 12:00:OOAM 0.00 gallons ❑Yes ❑ No UPCF(12/99 revised)