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0FIED PROGRAM CONSOLIDATED FORM TANK: TADS15733 .L PRN: PRO523164 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FAD015636 two pages per tank) TYPE OF ACTIONPage 2 of 3 (C1 ek mtyitem only) ElI NEW SITE PERMIT ❑ 4 AMENDED PERMIT El5 CHANGE OF INFORMATION E]6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT II ❑STANK REMOVED 430 BUSINESS NAME(Sx«n FACILITY NAME or DBA-Doing Baainm Aa) FACILITY ID: PRN: I STOCKTON REDEVELOPMENT AGENCY 3 FA0015636 PR0523164 LOCATION WITHIN SITE(opn«a0 666 W WEBER AVE,STOCKTON 431 PHONE 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.) TAMC IDN 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0515733 UNKNOWN If'Ye,Complxe«CpaV FO(mCECamPem«nL DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 437 500 ADDITIONAL DESCRIPTION(For 1.9 n:e only) 439 U.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED E] 2 LEADED ❑ 5.JET FUEL pfrnk cmplem Pmolemn Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL M 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(frau Hmudpaa Maimiala i.mlmy Inge) 441 CAS#(tram HaaeN«s Matenate Imxtay page) 442 ❑4.HAZARDOUS WASTE ancludas head Oil) ❑95.UNKNOWN 111.TANK CONSTRUCTION TYPE OF TANK ® 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5,SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chxg acitmi only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ❑2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank M 1,BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Ch .'mu aJy) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100'.METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Chxk one i.only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/IWI.METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑5.CONCRETE TANK INTERIOR LININGE] L RUBBER LINED ❑3.EPDXY LINING ❑ 5.GLASS LINING E]95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Chxk mn ium xdy) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ®99.OTHER (F«I«al uu a^ty) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Chxk one my) E]4 IMPRESSED CURRENT ® 99 OTHER ❑ 2SACRIFlCW.ANODE (F«lauluuonly) SPILL AND OVERFILL YEAR INSTALLE450 TYPEO«aluxonly) 451 OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED 452 (Chxk all mn apply) ❑ I SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAD ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A d mpu«or 0x mmrimtinng promote.aanbe,mbmetai to the local ay.) IF SINGLE WALL TANK(Chxk all met apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Ckck«mteen only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST�SEwD YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK 1 1""f D S �- El Yes El No UPCF(12/99 revised)