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IFIED PROGRAM CONSOLIDATED FORK TANK: TA0515429 PR#: PR0231055 UNDERGROUND STORAGE T TAN PAf 1 FAC#: FA0002321 Z�,J (two pages per tank) Page 2 of 5 TYPE OF ACTION -I' •Z 0 (Chock only item only) ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE ORMATION E] 6 EMPO Y SrfE CLOSURE [:] 7 PERMANENTLY CLOSED ON SITE (Specify,reason-for local use Doty) (Speckly reason-for local we only) ❑ 3 RENEWAL PERMIT j ❑8 TANK REMOVED 430 BUSINESS NAME(same as FAca1TY NAW or DBA-Doing etuiness As) FACILITY ID: PR#: UNITED GAS 3 FA0002321 PR0231055 LOCATION WITHIN SITE(Optional) 440 W CHARTER WAY,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#: 10 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0515429 TRUSCO If"Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) a3s TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10/1/1999 12:00:OOAM 20,000 ADDITIONAL DESCRIPTION(For local use only) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL (if marked complete PetrolcmType) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ lc.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(Ecom Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4.HAZARDOUS WASTE (Includes Used Oil) ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item 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 (Check one item only) ❑2.STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Check one item only) ❑ 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 ❑ 1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check one item only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99.OTHER (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 44 9 PROTECTION IF APPLICABLE PROTECTION (Check one item only) ❑4 IMPRESSED CURRENT ❑99 OTHER ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 45' (Chalk all fMet apply) ® I SPILL CONTAINMENT ® I ALARM ®3 FILL TUBE SHUT OFF VAL' ❑X 2 DROP TUBE ® 2 BALL ❑4 EXEMPT Q 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) (Chockone nem only) ❑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 (SIR)BIENNIAL TANK TESTING ❑3 MANUAL MONITORING ❑99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 10/1/1999 12:00:00AM 0.00 gallons ❑Yea ❑No UPCF(12/99 revised)