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FIED PROGRAM CONSOLIDATED FORM TANK: TA0504863 PR#: PRO231173 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0006423 " (two pages per tank) TYPE OF ACTION Page 4 of 7 (Cherkatyisenonly) ❑ I NEW SITE PERMIT ❑4AMENDED PERMIT ❑ 5CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ IftENEWAL PERMIT ❑ 8TANK REMOVED 430 BUSINESS NAME(Smeu FACILOYNAMEerDBA-Do,,Business As) FACILITY ID: PR#: 1 UNITED GAS FA0006423 PR0231173 LOCATION WITHIN SITE(Optional) 3440 E MAIN ST,STOCKTON 431 PHONE 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# Tank#: 5 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ❑No 434 TA0504863 TRUSCO If"Yea"",mnpkleow page rorearh cwnparvM,t. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10/21/1993 12:00:OOAM 10,000 ADDITIONAL DESCRIPTION(F«wdaeonly) 439 IL TANK CONTENTS TANK USE 4J9 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ❑ Is.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (IfmarkW mnplge Prtmkum T>lre) ® Ib.PREMIUM UNLEADED ❑ I.DIESEL ❑ b.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.M1DGRADEUNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(fewn FWardous Ma nMs lnvee o page) 441 CAS#(fmm Hv .MmensK Invrntory page) 442 ❑4.HAZARDOUS WASTE (molwes urea oil) ❑95.UNKNOWN 111.TANK CONSTRUCTION TYPEOFTANK 1,SINGLE WALL ❑ 3.SINGLE WALL WITH E] S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chert'oa iron only) EXTERIOR MEMBRANE LINER ❑ 95 UNKNOWN ®2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ I.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (ChkamitemaJy) ❑2.STAINLESS STEEL ® STEEL CLAD WNBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(I") ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (peek one tan od5) ❑2.STAINLESS STEEL ®4.STEEL CLAD W/FIBERGLASS ❑ 8.FRPCOMPTIBLEW/lOVKMETHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANKINTERIORLINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING E]95.UNKNOWN 445 DATEINSTALLED 447 OR COATING (Ch .imn orly) ❑2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (For loa uu mly) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATEINSTALLED 419 PROTECTION IF APPLICABLE PROTECTION (C crsa een]l) ❑ 2 SACRIFICIAL ANODE ❑ 4 IMPRESSED CURRENT ❑ 990THER (Forloa use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(loaluconly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (CheAellthaapply) M I SPILL CONTAINMENT 1,993.00 ❑ IALARM M 3 FILL TUBE SHUT OFF VAL` 1,993.00 Q 2 DROP TUBE 1,993.00 ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(Adesviptim ofgc mnnno,in,progrvn shall be submittal toshe local agenn:) IF SINGLE WALL TANK(CMk all as apple) 453 IF DOUBLE WAIL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Cherkacimnonh) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑3 CONTINUOUS ATG - ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 990THER V.'I'ANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 455 TANK FILLED WITH INERT MATERIAL? 457 ❑ Yes ❑ No UPCF(12/99 revised)