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FIED PROGRAM CONSOLIDATED FORMI I 6 TANK: TA0198403 PR#: PR0231984 UNDERGROUND STORAGE TANKS -TAN AG �/��J�FAC#: FA0001393 1 F11�� -(two pages per tank) Page 2 of 9 TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Clack only item only) -- ?1 ❑ 7 PERMANENTLY CLOSED ON SITE (Spaafj reason wrlad use ody) [Spcory nasoa-6r oral use only) 3 ❑ 3RENEWAL PERMIT ❑87ANK REMOVED 430 BUSINESS NAME(Samc as FACILITY NAME m DBA-Doing Boahwa Aa) FACILITY ID: PR#: 1 MANTECA LIQUOR&FOOD 3 FA0001393 PR0231984 LOCATION WITHIN SITE(oplim t) 890 N MAIN ST,MANTECA 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#: 3 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0198403 11`^Yw-,waplelecnepagefineachmnPmunene DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 12,000 ADDITIONAL DESCRIPTION(For local we only) 439 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 44o ® I.MOTOR VEHICLE FUEL ® Ia.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL pfmakduuplac Fetrolemn Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(6vm Flan w Malvials lmmlmy page) 441 CAS#(t Hmrmu Malcisls Immwy page) 142 ❑ 4.HAZARDOUS WASTE (Iimladu Usm oil) ❑ 95.UNKNOWN ID.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chak me iron my) 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 (Chakoaltemonly) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ L BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check aoe iron anty) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ S.CONCRETE TANK INTERIOR LINING ❑ L RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LININGa7 OR COATING ❑95.UNKNOWN a4s DATE INSTALLED (Chat oro a..*) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99.OTHER (Farlaml ucanly) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (C konea.only) ❑ 4 IMPRESSED CURRENT E] 99 OTHER ❑2 SACRIFICIAL.ANODE (Fulonl ucody) SPILL AND OVERFILL YEAR INSTALLE150 TYPE(Iwlueanly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chale all oat apply) ® 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 1 FILL TUBE SHUT OFF VAL' ❑ 2DROP TUBE ❑ 2BALL ❑ 4EXEMPT ❑ 3STRIKER PLATE FLOAT N.TANK LEAK DETECTION(A duvi pion ofthe nwnitermgpmgraw shill be so vwaned w Ne last ager y) IF SINGLE WALL TANK(Chak all dat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chak me it.odY) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE 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)BIENNIN.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)