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0FIED PROGRAM CONSOLIDATED F y it, cc t'�'�KS UNDERGROUND STORAGE TANKS TANK PAGE 1 1-91-13 3 /0.2-(two pages per tank) I'Mc 5 of 6 TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Checkenckcmonly) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Spaifyreason-for local meanly) (Specify reason-for local use only) ❑ 8 TANK REMOVED .. 430 BChevron Station#91452 USINESS NAME(Stem m FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID: 0 0 O 0 0 0 0 0 0 0 0 LOCATION WITHIN SITE(optional) F,1.�o,371q 431 334 E Main St.,Ripon,CA 95368 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# 932 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes ® No 434 ff '" D XERXES If"Yes',complete one page for each compenment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10/1/95 12000 0 ADDITIONAL DESCRIPTION(For local we only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ifmarkd complete Petroleum Type) ®Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑to. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Heemdom Mistrials lowntery page) 441 CAS#(from Heeardom Materials Inventory page) 442 ❑4. HAZARDOUS WASTE Oriduda Used Oil) PREMRJM UNLEADED 800-61-9 ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK [11. SINGLE WALL ❑3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ®2. DOUBLE WALL ❑4. SINGLE WALLIN VAULT ❑99. OTHER_ TANK MATERIAL-primary tank ❑ 1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE El 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99.OTB ER_ REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tatdr ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE [195, UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ S. CONCRETE TANK INTERIOR LINING [11.RUBBER LINED ❑3.EPDXY LINING ❑S.GLASS LINING [195.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 19 6 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑I MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 098 448 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEARINSTALLED 450 TYPE(localmeonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 451 (Check all that apply) ®1 SPILL CONTAINMENT ®3 FILL TUBE SHUT OFF VALVE 1995 ® 1 ALARM OPW 61-SO-4 N 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 programshall be submit w tM local agency) IF SINGLE WALL TANK(check all that apply) 453 1F 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(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) 177 Formerly SWRCB Form B