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FIED PROGRAM CONSOLIDATED FORM qw INK: TA0198406 401jPR#: PR0231984 UNDERGROUND STORAGE TANKS -TANK PYYYFAC#: FA0001393 o pages per tank) TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5 CHANGE OF INFORMATIONonly) Page8 of (Chmk only iron ❑6 TEMPORARY SITE CLOSURE (6pmry«amn-fmbml�se oWvl (Spmity rmaon-tor bml use aiy9 ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT _ � BTANK REMOVED 430 BUSINESS NAME(same as FACILITY NAME or DBA-Dome Bmimaa At) FACILITY ID: PR ft: 1 MANTECA LIQUOR&FOOD 3 FA0001393 PR0231984 LOCATION WITHIN SITE(optima0 890 N MAIN ST,MANTECA 431 PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subrrdmd to the local agency.) TANK ID# Tank#: 6 432 TANK MANUFACTURER 411 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0198406 H^Yot aomplem OMNV for oam magammmt DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 432 550 ADDITIONAL DESCRIPTION(For local a seamy) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ❑ I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (IfmarkW corr,lne Pmol4 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(aum Haardom Malctab lmmmrypa8e) 441 CAS#(fiom Haaardom Matmiab ln,owny page) 442 M 4.HAZARDOUS WASTE (1.1W UzW Oil) ❑95.UNKNOWN ID.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chr ..itanony) 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 (Check one irem only) ❑2.STAINLESS STEEL ❑ STEEL CLADW/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN w5 (Cl onoilenaNy) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ ".OTHER ❑5.CONCRETE TANK INTERIOR LINING ❑ L RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING FC okomuen omy) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED ❑ 99.OTHER (Far lain ma Dory) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN me DATE INSTALLED H9 PROTECTION IF APPLICABLE PROTECTION (CTmkm iunianb) ❑ 2 SACRIFICIAL ANODE ❑4 IMPRESSED CURRENT ❑ 99 OTHER (Fwlaal meamy) SPILLANDOVERFILL YEAR INSTALLE45o TYPE(lomlmcamy) 431 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chink a6 wt appy) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL' ❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A 4mOriptina ofinemmaadns pmemn snail besubmVam on de local ad ,) IF SINGLE WALL TANK(Chmkall that appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) F�wkoncnvnmly) ❑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)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 ❑Yea ❑No UPCF(12/99 revised)