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v TIFIED PROGRAM CONSOLIDATED FC 4 y Lalle TANKS UNDERGROUND STORAGE TANKS TANK PAGE 1 16 II two pages per tank) Page 5 of 6 TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (check one dem only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Spaify rcawn-for kcaluu only) (Specifyreuan-forloealmeonly) ❑ STANK REMOVED 430 1 BUSINESS NAME(Smite u FACILITY NAME mDBA-Wing auamas A%) 3 FACILITY ID: 0 0 0 0 0 0 0 0 0 0 0 Chevron Station#91848 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# 7 432 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK ❑Yes M No 434 ThDI D OWENS CORNING Ir"Ye:•,completeone Page for eachcorpanmcnt. DATE INSTALLED( EAR/MO) 635 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 07/11/91 12,000 0 ADDITIONAL DESCRIPTION(P«tocol aae only) 438 11.TANK CONTENTS TANK USE a39 PETROLEUM TYPE 4ao ®1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ir mmked eno leee PeWleu.Type) ®Ib. PREMIUM UNLEADED 03. DIESEL 06. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (born Heenriom Mmerials Inventory page) 401 CAS#(6nm Haam -Matmals Inventory page) 442 ❑4. HAZARDOUS WASTE (mek lj,eeoi0 PREMIUM UNLEADED 800-61-9 ❑95.UNKNOWN II1. TANK CONSTRUCTION TYPE OF TANK 01. SINGLE WALL ❑3. SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (C kone iter only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 02. DOUBLE WALL ❑4. SINGLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL-primary tmik [11. BARE STEEL ®3. FIBERGLASS/PLASTIC 0 5. CONCRETE ❑95. UNKNOWN 444 (Chxk one nem only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%.METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) TANK MATERIAL-secooie,,� ❑ 1. BARE STEEL 03. FIBERGLASS/PLASTIC 05. CONCRETE 095. UNKNOWN 445 (Check arc nemonly) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [38. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑ S. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING N 6 UNLINED ❑99 OTHER ((heck enc nemonly) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 44g 448 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one nem only) ❑2 SACRIFICIAL ANODE (For kcal use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Ch t all una apply) ®3 FILL TUBE SHUT OFF VALVE ®I SPILL CONTAINMENT 1991 ®1 ALARM OPW 61-SO4 ®2 DROP TUBE 1991 OP W 61-SO-4 ❑2 BALL FLOAT _ ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf W.TANK LEAK DETECTION(A d iption ofdmonin.6,nn,.shall 1,e summiucd to the kcal agency) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item 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(YWMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 4% TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) 177 Formerly SWRCB Form B