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FIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page 5 of 1 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT !xl s_CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) ✓ ❑ 7 PERMANENTLY CLOSED ON SITE (Specify reason-for local use only) (specify rcasmt•for local use only) ❑ 3 RENEWAL PERMIT ❑STANK REMOVED 430 BUSINESS NAME(Same az FACILITY NAME or DBA-Doing Business As) FACILITY ID: I STOCKTON USD-CORP YARD ' FA0004016 5 LOCATION WITHIN SITE(optional) 431 PHONE 1. 1'.kNK 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# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑yes No 434 11.00 MODERN WELDING Ir^Yes•,completeonepage foreach comparnnent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 15,000 ADDITIONAL DESCRIPTION(For Iota)use only) 4 j, II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® L MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Irmarkedcornplete Peoroleton Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ lc.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 44, ❑4.HAZARDOUS WASTE (Includes Used oil) REGULAR ❑95.UNKNOWN M.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 44; (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/1000/6 METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Chak 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 ❑ I.RUBBER LINED ❑3.EPDXY LINING ❑ 5.GLASS LINING ❑ 95.UNKNOWN 446 DATE INSTALLED 44, OR COATING (Check one item only) ❑ 2 ALKYD LINING ❑4 PHENOLIC LINING Q 6 UNLINED ❑ 99.OTHER (For local use only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC 4 n PROTECTION IF APPLICABLE PROTECTION ® 3 FIBERGLASS REINFORCED PLASTIC E] 95 UNKNOWN 448 DATE INSTALLED (Check one item only) ❑4 IMPRESSED CURRENT E]99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(coal use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) 1 SPILL CONTAINMENT 1996 2 DROP TUBEEl1 ALARM 3 FILL TUBE SHUT OFF VALVE [-] 2 BALL FLOAT ❑4 EXEMPT 3 STRIKER PLATE 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 4,4 ❑ 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) F13 CONTINUOUS ATG ❑ 7 GROUNDWATER tj 2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING W❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING [:199 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YWMO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons El Yes ❑ No UPCF(12/99 revised) Iz13f i r