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44 <br /> IFIED PROGRAM CONSOLIDATED FORNO TANK: TA0508321 <br /> vPH . <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 �I <br /> Z I u v FAC#: FA0002347 <br /> (two pages per tank) <br /> Page 4 of 7 <br /> TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (Chale oNy itcmaNy) ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 <br /> BUSINESS NAME(Snme as FACILITY NAME w DBA-Doing Business Ae) EACH=ID: PR#: <br /> 1 <br /> ERNIES GENERAL STORE 3 FA0002347 PRO231761 <br /> LOCATION WITHIN SITE(Optional) 4407 E WATERLOO RD,STOCKTON 431 <br /> PHONE <br /> 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.) <br /> TANK ID# Tank#: 5 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [:]Yes ❑No 434 <br /> TA0508321 I UID CONTAINMENT INC Yves^,mmpkwnmp g ro a a mgaw mt <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 12/29/1998 10-10-00 <br /> ADDITIONAL DESCRIPTION(Pw]waI merry) 439 <br /> IL TANK CONTENTS <br /> TANK USE 431 PETROLEUM TYPE 44a <br /> ® <br /> I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL <br /> (Itanat eoe,keepeboksue Type) ❑ Ib.PREMIUM UNLEADED N 3.DIESEL ❑ 6.AVIATION FUEL <br /> ❑2.NON-FUELPETROLEUM ❑ Ic MIDGRADEUINLEADED ❑4.GASOHOL [-199.OTHER <br /> ❑ 3.CHEMICAL PRODUCT COMMON NAME Loan Henasdout Mmeo.L lmesamPage) 441 CAS#(awn Hasaedous Mamials lmasu ypage) 442 <br /> ❑4.HAZARDOUS WASTE <br /> (I.kAee Uscdoi0 <br /> ❑95.UNKNOWN <br /> M.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ L SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Cnxkamitcmonly) EXTERIOR MEMBRANE LINER ❑ 95.UNIWOWN <br /> ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑99.OTHER <br /> TANK MATERIAL-primary look ❑ 1.BARE STEEL N FIBERGLASS/PLASTIC [15.CONCRETE ❑ 95.UNKNOWN a4I <br /> (Cheek oro item and') ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL <br /> REINFORCED PLASTIC(FRP) ❑ 99.OTHER <br /> TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 <br /> (Cheekmeitan.*) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD WNIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL <br /> REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER <br /> ❑ 5.CONCRETE <br /> TANK INTERIOR LINING ❑ I.RUBBER LINED El3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING <br /> (Chakominmmly) E] 2ALKYD LINING ❑ 4PHENOLIC LINING [j6UNLINED El 99OTHER (For lod me mmy) <br /> OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC N 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN "a DATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑4IMPRESSFD CURRENT ❑ 99 OTHER <br /> (Chin:meitem wily) ❑ 2SACRIFICIAL ANODE (Fm lural me wdy) <br /> SPILL AND OVERFILLYEAR INSTALLE50 TYPE(I.I...Iy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Cheek all that apply) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL` <br /> ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT <br /> ❑ 3 STRIKER PLATE FLOAT <br /> IV-TANK LEAK DETECTION(A dnwipdmarthe mmmtwtngmos msball be eareub i w the lora]agency.) <br /> D'SINGLE WALL TANK(Chakall that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (C orcuewmty) <br /> ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING <br /> (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> 12/29/1998 0.00 gallons ❑Yes ❑ No <br /> UPCF(12/99 revised) 0 <br /> • <br />