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r _ �� TANK: Tp05048D2 FLED PROGRAM CONSOLIDATED FORM y- r PR#: pA0504802 +� U1� 1756 AC#: FA0006343 UNDERGROUND STORAGE TANKS - TANK PAGE (two paves per lank) Page 6 of 7 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PI.RNIIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) ____ ,� ❑ 7 PERMANENTLY CLOSED ON SITE �3 RENEWAL PERMIT (Speifyrcasan.,tbr total use only) (Spmry reason-for localyse only) L]8TANK REMOVED 430 BUSINESS NAME(Same as.FACILITY NAME or DBA-Doing 13sines,a) :FAO006343 ILITY lL). PR !: FAST GAS* ' r PRO231756 LOCATION WITHIN SITE(Optional) 2350 E WATERLOO RD,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plat plan with the location of the UST system including buildings and landmarks shall Ice submitted to die local agency.) TANK LD# Tank#: 6 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes [$No 434 TA0504802 TRUSCO tr^Yes complete one page for each comparurcent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1212/1993 10 000 ADDITIONAL DESCRIPTION(For local use only) 439 ]I-TANK CONTENTS TANK USE 439 PETROLEUM TYPE 446 ® L MOTOR VEHICLE FUEL ❑ I a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmarkedcompk(cPetmltmmTypc) jIb.PREMIUM UNLEADED 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Invmtorypage) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4.HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN CA V C El� II1.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3,SINGLE O MEMBRANE LINER ❑ 5-SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 95.UNKNOWN (Check one it-only) ® 2.DOUBLE WALL [] 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Ch"k one item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD WIFIBERGLASS ❑ 8.ERP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99-OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS!PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check one item only) ❑2.STAINLESS STEEL ❑4.STEEL CLAD WIFIBERGLASS ❑ 8.FRF COMPTIBLE WlI00%METHANOL REINFORCED PLASTIC(FRP) ❑ to.COATED STEEL ❑ 99.OT14ER ❑ 5.CONCRETE 447 TANK INTERIOR LINING pL RUBBER LINED ❑ 3.EPDXY LINING E] 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED OR COATING ❑ 99.OTHER [Chock one item only} ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑6 UNLINED (Farhat use only) 449 OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER (Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) YEAR INSTALLE450 TYPE(total use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 SPILL AND OVERFILL J�}z LL I SPILL CONTAINMENT 1,993.00 1 ALARM 1I f`nJ ® 3 FILL TUBE SHUT OFF VAL' +ti (Check all That apply) //�� 2 DROP TUBE `�I7 2 BALL ( - ❑ 4 EXEMPT 3 STRIKER PLATE i t C.{�J FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program sha14 be submitted to the)=I agency.) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 IF SINGLE WALL TANK(Check all that apply) ¢Check one item only) ❑ VISUAL(EXPOSED PORTION ONLY) E] 5 MANUAL TANK GAUGING(MTG) ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE F-13 CONTINUOUS ATG ❑ 7 GROUNDWATER 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MD/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12199 revised)