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IFIED PROGRAM CONSOLIDATED FORKd JZ q�13L TANK: TA0515430 ( C PR#: PR0231055 UNDERGROUND STORAGE TANKS - T PAGi FAC#: FA0002321 Sb i U (two pages per tank) TYPE OF ACTION Page 4 of 5 (Check only iron only) ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE (Specify reason-for local rue only) (Specify reason-for local tue only) ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: I UNITED GAS 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#: I I 43Y TANK MANUFACTURER q33 COMPARTMENTALIZED TANK [:]Yes ❑No 434 TA0515430 TRUSCO If"Yes•,complete one page for each compartment" DATE INSTALLED(YEAWMO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10/1/1999 12:00:OOAM 10,000 ADDITIONAL DESCRIPTION(For local use only) 41X H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® L MOTOR VEHICLE FUEL ❑ I a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (If murWcomplete petroleum Type) ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL [:16.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ I c.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAMEfrom Hanrdous Materials Inventory a CAS#(from HarardM ous Materials Inventory( 7 el P g 441 f ( fige) 442 ❑4.HAZARDOUS WASTE (Modes Used Oil) ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cheek one item 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 (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 ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑5.CONCRETE ❑95.UNKNOWN 141 (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 ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑3.EPDXY LiMNG447 OR COATING ❑5.GLASS LINING ❑95.UNKNOWN a46 DATE INSTALLED (Check one item only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99.OTHER (For local we only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ (Check one item only) ❑2 SACRIFICIAL ANODE 4 IMPRESSED CURRENT E]99 OTHER (For local we only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED >' (Check all that appy) M I SPILL CONTAINMENT ® I ALARM ®3 FILL TUBE SHUT OFF VAL' X❑ 2 DROP TUBE ❑ 2 BALL ❑4 EXEMPT 0 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 appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER a« ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item 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 ❑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 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 41' 10/1/1999 12:00:OOAM 0.00 gallons ❑Yes ❑No UPCF(12/99 revised)