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IFIED PROGRAM CONSOLIDATED FORMI TANK: TA0172803 ' ` PR#: PR0231728 UNDERGROUND STORAGE TANKS -TANK P H/I&p FAQ#: FA (two lnges p to TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION 6 TEMPORARY SITE CLOS e6or7 ❑ (Check oNynem omy) Fl 7 PERMANENTLY CL OS ED ONSIT /� ❑ 3RENEWAL PERMIT (SPatS reason Tor local tn<ooly) 1Spaitrrwson-ro<lural me Doty) 8TANK REMOVED / /( BUSINESS NAMES.as FACILITY NAME m DBA-Doing Buinas:\st FACILITY ID: PR#: UNIVERSAL SWEEPINGS SERVICES FA0003565 PR0231728 L LOCATION WITHIN SITE(opuamp 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 submitted to the local agency) TANK ID# Tank#: 3 432 TANK MANUFACTURER 433 COMPARTMENTAI I ED TANK ❑ye ❑No 4x TA0172803 Ir'Ya'.eompi<m aaewg<rvrwan rompamtw� DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 550 ADDITIONAL DESCRIPTION(Fm IoW me Doty) 438 II.TANK CONTENTS TAMC USE 439 PETROLEUM TYPE 440 ❑ I.MOTOR VEHICLE FUEL ❑ Is.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Irmarkvlcomplete?m kwnType) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑b.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCE COMMON NAME(ft.H.- Matviah Immt ® 4.HAZARDOUS WASTE ( arY page) 441 CAS#(fiom Haurdmn Mataiak lnvmtory Page) 442 (Imlmlm U'W Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPEOFTANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM a3 (Cneckamacnonly) 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 (Cneh ftan only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD WNIBERGLASS ❑ 8.FRP COMPTIBLE W/ItXWA METHANOL REINFORCED PLASTIC(FRP) [199.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE [:195.UNKNOWN 445 (Gnat mriam only) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD WTIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED OR COATING ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.IINKNOWN 446 DATE INS ALLED a7 (Click we immmdY) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED ❑ W.OTHER (Pmlowl eddy) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN Hs DATE INS ALLED 449 ❑ (Chak one item Dory) ❑ 41MPRESSED CURRENT E] 99 OTHER F1 2SACRIFlCIAL ANODE (Fm bul only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE((awl memory) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Clvek all Wteppty) ❑ I SPILL CONTAINMENT [I IAT-ARM ❑ E]3 FILLEXE TUBE SHUT OFF V ` 2 DROP TUBE 4EXE E] FLOAT 3STRIKER PLATE ❑ ❑ MPT FLOAT N.TANK LEAK DETECTION(A dmeipio arflewdwrin8 pmsm.,lon n< nin<a m a<Tool as y.) IF SINGLE WALL TANK(Chak alhlmupply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chinkm 1=mty) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑6VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER C]3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATEDD TE ASST 2USE (YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH VERT MATE ? 457 U ❑Yes ❑ N UPCF(12/99 revised)