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• IED PROGRAM CONSOLIDATED FORM I � TANK: TA0505758 PR#: PR0231665 UNDERGROUND STORAGE TANKS - TANK PAGE 1 FAC#: FA0003714 (two pages per tank) Pope 2 of 7 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Clxk only ima only) '. ❑ ]PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT (Spozifyrmast-forloaluscody) (Spxiyswson forlowti¢cony) ❑ 8TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PRI;: 1 CHEVRON USA INC#91452"` 3 FA0003714 PR0231665 LOCATION WITHIN SITE(optimal) 334 E MAIN ST,RIPON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted W the local agency.) TANK ID# Tank#: 6 432 TANK MANUFACTURER 413 COMPARTMENTALIZED TANK E]Yes 7LNo 434 TA0505758 XERXES If-Ya',amnPmemepaperoroachi mpanmml. DATE INSTALLED(YEAR/MO) q36 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 8/1/1995 12,000 ADDITIONAL DESCRIPTION(For kcal use Dory) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 940 ® I.MOTOR VEHICLE FUEL ex..REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL 0rmakd mmpinc Pcwlam Type) *lb.PREMIUM UNLEADED [j3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ 1c.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME uma,Naamo o Mamials Immm owe) 441CAS#(from Haamdous Ma mals nvm yPaB e) uz ❑ 4.HAZARDOUS WASTE 0xkmusmDa) 30CLO - [j95.UNKNOWN tai 111.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Clcakanc it.only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIA.-primary lank ❑ 1.BARE STEEL M FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 444 (Chxkom itan only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99,OTHER TANK MATERIAL-secondary tank ❑ LBARE STEEL 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check am item only) ❑ 2.STAINLESS STEEL ❑4.STEELCLADW/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING44] OR COATING ❑ 5.GLASS LINING ❑95.UNKNOWN 44e DATE INSTALLED (Checkone irnmonly) ❑2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Por Ixal me only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (C6xkmmitmsmuy) ❑ 4 IMPRESSED CURRENT El 99 OTHER ❑ 25ACRIFICW.ANODE For local us<only) SPILL AND OVERFILLYEARINSTALLE450 TYPEdoalusemy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR STALLED 452 (ChxkallWnappy) Ito I SPILL CONTAINMENT 1,995.00 ❑ 1ALARM opW UIL-C-),I/�IL�[TJ(�y.Bl $WIT FVAL` 2DROP TUBE ❑ 2BALL ❑ 4EXEhTRf 1 ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A ilmmpuoaorlhe manbaimpro mn shall In sabmiuW to as laod mcsiy) IF SINGLE WALL TANK(Claxk all thatapply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chxk cane ucmaay) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING M 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.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 ❑Yes ❑ No UPCF(12/99 revised)