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s i to FIED PROGRAM CONSOLIDATED FORM 1 (� TANK: TA017280I e 1 PR#: PRO231728 UNDERGROUND STORAGE TANKS -TANIPA FAC#: 003565 (two p p nk1b P g 2 7 U TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CL U (Cb¢kaalyitanonly) ❑7 PERMANENTLY CLOSEDNSITE p11 ❑ 3RENEWAL PERMIT STANK REMOVED 4 IJIu'Pj BUSINESS NAME(Same as FACILITY NAME m DBA-DebtsBushtwe Aa) FACILITY ID: PR p: UNIVERSAL SWEEPINGS SERVICES FA0003565 PRO231728 LOCATION WITHIN SITE(opnaea0 1113 SHAW RD,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subnutted m the local agent ) TANK ID# Tank#: 1 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Ye ❑No 434 TA0172801 ff Ycs",catryleteone Vager eacheompamnent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS436 NUMBER OF COMPARTMENTS 437 2 000 ADDITIONAL DESCRIPTION Hor local we only) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED E] 5.JET FUEL pTmarkd mmpinc PcwkwnTra) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL F13.CHEMICAL PRODUCT ❑ 99.OTHER ❑ O.HAZARDOUS WASTE Mrial COMMON NAME(man Haaaraom atelmemmyMe) 941 CAS#(rout Ha ebbee MatenaHlmen0,page) 442 (Includes Usdoi0 ❑ 95.UNKNOWN M.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chcck one item only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ® 95.UNKNOWN 444 (Chock one item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) [199.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN 445 (Checkowitemonly) ❑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 ❑ I.RUBBER LINED 3.EPDXY LINING OR COATING ❑ ❑ 5.GLASS LINING ®95.UNKNOWN 446 DATE INS ALLED 447 ((Iick on<I=only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ❑99.OTHER (Far bol only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC95 UNKNOWN a4s DATE MS ALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ (Chock mu itrn only) ❑ 4 IMPRESSED CURRENT El 99 OTHER ❑ 2SACRIFICIAL ANODE (Fm tool t soonly) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(medweonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chock all that apply) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF V ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT FV.TANK LEAK DETECTION(A desuptlot arms monhonn8pm®am snan be solutions to me Intl aymey) IF SINGLE WALL TANK(Chock ill mat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Checkow item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3CONTIN000S ATG ❑ 7GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING (SIR)BIENNIAL TANK TESTING F-199OTHER 3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATI LAST U ED(YR/MO/DAY) 455ESTIMATED QUANTITY OF SUBSTANCE REMAINING a56 TANK FILLED WITH INERT MATE 457 7i 0 ❑Yes ❑N UPCF(12/99 revised)