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,,,,sIFIED,PROGRAM CONSOLIDATED FG,.of TANKS UNDERGROUND STORAGE TANKS TANK PAGE 1 lD11l�oa (two pages per tank) Page I of 6 TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one nem only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Speeifyreason-forlocaluseonly) (Specifyreason-forlucaluseonly) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID: 0 0 0 0 0 0 0 0 0 0 0 Chevron Station#91848 370 LOCATION WITHIN SITE(optional) 431 1257 W.Yosemite Ave.,Manteca CA 95336 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#5- 432 TANK MANUFACTURER433 COMPARTMENTALIZED TANK [-]Yes No 434 1 &399 OWENS CORNING If'Yss',wm laennemeforeacbconiWn t. DATE INSTALLED(YEAR/MO) 035 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 07/11/91 12,000 0 ADDITIONAL DESCRIPTION(For kneel use ony) 438 II.TANK CONTENTS TANK USE 639 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ®la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ifmark4d conglac Pctroknm Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑to. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Maesials Inventory page) 401 CAS#(from narndous Mmerials Inventory page) 402 [14. HAZARDOUS WASTE (Includes U: Oil) REGULAR UNLEADED 800-61-9 ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [13. SINGLE WALL WITH U 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one nem only) EXTERIOR MEMBRANE LINER [195, UNKNOWN 02. DOUBLE WALL ❑4. SINGLE WALL IN VAULT [199. OTHER_ TANK MATERIAL-p hay,,aak ❑1. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE 095. UNKNOWN 444 ((hock one nae only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(PRP) TANK MATERIAL-secondary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN M5 (Check.nem only) [12. STAINLESS STEEL [14, STEEL CLAD W/FIBERGLASS [19. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING [11.RUBBER LINED 0 3.EPDXY LINING ❑5.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Check ase nem only) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN sae sae PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Cheek one nemonly) ❑2 SACRIFICIAL ANODE (For lural use only) SPILL AND OVERFILL YEARINSTALLED 450 TYPE(bcaluseonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Q kali that apply) ®I SPILL CONTAINMENT03 FILL TUBE SHUT OFF VALVE ]991 ®1 ALARM OPW 61-SO-4 ®2 DROP TUBE 1991 OPW 61-SO-4 ❑2 BALL FLOAT _ ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf IV.TANK LEAK DETECTION(A description ottbe monrtoring program shall be submrttodto the local agency.) IF SINGLE WALL TANK(chsok all tnat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 450 (Cheek one nem only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER _ IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) 173 Formerly SWRCB Form B