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„.,IFIED PROGRAM CONSOLIDATED FGA TANKS UNDERGROUND STORAGE TANKS TANK PAGE 1 (two pages per tank) Page 1 of 6 TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one it.only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Speci"mon-forbcalumonly) (Specifymason-forlouelmeonly) ❑ STANK REMOVED 430 BUSINESS NAME(satrnatFAaurr NAMEwonA-wing ausineas As) 3 FACILITY ID: 0 00 0 0 0 0 0 Chevron Station#91848 LOCATION WITHIN SITE(optiomil 431 1257 W Yosemite Ave.,Manteca,CA 95337 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# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes ® No 434 1 GWENS CGRNING If-Ym',complere one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 7/11/91 12000 0 ADDITIONAL DESCRIPTION(For coral use only) 438 II.TANK CONTENTS TANK USE 639 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ®la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ifmarkecloo"IerePewlwm Type) ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL [12. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED [14. GASOHOL [199.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Haaardaue Materials?memory page) 401 CAS#(onto Harardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Ineludo use l oa) REGULAR UNLEADED 800-61-9 ❑95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chink one ven only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL ❑4. SINGLE WALLIN VAULT [199. OTHER_ TANK MATERIAL-primrytaNs [11. BARE STEEL ®3. FIBERGLASS/PLASTIC [:15. CONCRETE ❑95. UNKNOWN 444 (Chink one i¢toonly) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FTBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL [199.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary mass 0 1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE 095. UNKNOWN 445 (Check one veto only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/1007e METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED 3.EPDXY LINING [15.GLASS LINING [195.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN ae us PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(Iwai use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ®1 SPILL CONTAINMENT ®3 FILL TUBE SHUT OFF VALVE 1991 ®1 ALARM OPW 61-SO-4 ®2 DROP TUBE 1998 OPW 61-SO-4 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf IV.TANK LEAK DETECTION(A description of the monitoring engram shall be submitted to the local agency.) IF SINGLE WALL TANK(Cheek as that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 050 (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(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAININGFILLED WITH INERT MATERIAL? 457 056 TANK gallons ❑Yes ❑ No UPCF(1/99 revised) 173 Formerly SWRCB Form B