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FIED PROGRAM CONSOLIDATED FORM TANK: TA0198404 PRM PRO231984 UNDERGROUND STORAGE TANKS -TANK PAoQ ` FAC#: FA0001393 o pages per tank) ipvl Page 4 of 9 TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6TEMPORARY SITE CLOSURE (Chak only iron only) _. ❑ ]PERMANENCY CLOSED ON SITE (Sp 13 rason-for local lue only) (S,xify rason-for loaf ucc Dols) [:13 RENEWAL PERMIT ❑STANK REMOVED 430 BUSINESS NAME(Sam a FACILITY NAME or DBA-Doing Busies As) FACILITY ID: PR#: 1 MANTECA LIQUOR&FOOD 3 FA0001393 1 PR0231984 LOCATION WITHIN SITE(Dptimaq 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 subfmtted to the local agency.) TANK m# Tank#: 4 432 TANK MANUFACTURER 433 COMPARTMENTAT I ED TANK ❑Yes ❑No 434 TA0198404 It^Ya wmplaromva3c rm and anPammma DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 437 12,000 ADDITIONAL DESCRIPTION(Fm Iaal me only) 433 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® L MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmahalcompldc Fclsol4mo Typo) ❑ Ib.PREMIUMUNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑2.1,10N-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(aom Havr6om Materials lnvmlatypa3e) a41 CAS#(I=xaamoas Moteriat lavalmry page) 442 ❑4.HAZARDOUS WASTE (Imludes Used OS) ❑95.UNKNOWN HL TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CTak oso non only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Cneckarcimnooly) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/IN%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (C6akoacncmooly) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 4a OR COATING (OmI,ms ilan only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑ 6 UNLINED ❑ 99.OTHER (Forloalmeonly) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Omit on i(vn only) E]4 IMPRESSED CURRENT E] 99 OTHER ❑2 SACRIFICIAL ANODE (For Ircal mconly) SPILL AND OVERFILL YEAR NSTALLE450 TYPE(loalmonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chak dl slut appy) ❑ I SPILL CONTAINMENT ❑ I ALARM ❑ 3 FILL TUBE SHUT OFF VAL' ❑ 2 DROP TUBE ❑ 2 BALL ❑ 4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A description ortncmmdtmm3vmgmm shall besalmdtudto the local agony.) IF SINGLE WALL TANK(Ock all dust apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (C mu Item only) ❑2AUTOMATIC TANK GAUGING(ATG) ❑ 6VAIH)SE ZONE ❑ 1 VISUAL(SINGLE WALL N VAULT ONLY) ❑3 CONTINUOUS ATG ❑ ]GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑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)