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JNIFIED PROGRAM CONSOLIDATED FORW TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page 2 of 7 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AAIE`DED PERMIT ❑ 5 CHANGE OF NFOR ATION ❑6 TEMPORARY SITE CLOSURE (Check only item only) ❑7 PERMANENTLY CLOSED ON SITE (Specify reason-for local use only) (Specify reason-for local use only) ❑8 TANK REMOVED 430 ❑3 RENEWAL PERMIT BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: 1 STOCKTON USD-CORP YARD 3 �FA000�4016 431 LOCATION WITHIN SITE(Optiomq M2_ �� wn� PHONE I.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# 4S2 TANK iv1.�L\-UFACTURER 433 COMPARTMENTALIZED TANK ❑Yes o 434 10.00 MODERN WELDING If•Yes'.completeone page rmach comparnneru DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 20,000 ADDITIONAL DESCRIPTION(For local use only) 418 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED E] S.JET FUEL (Ifnurkedcomplete PeoolaonType) ❑ Ib.PREMIUM UNLEADED' ® 3.DIESEL ❑6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑ 4.HAZARDOUS WASTE (Includes Used 00) ❑ 95.UNKNOWN III.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/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ��❑....,,//3.FIBERGLASS/PLASTIC ❑ S.CONCRETE El 95.UNKNOWN 445 (Check one item only) ❑ 2.STAINLESS STEEL 4.STEEL CLAD W/FIBERGLASS [-] 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ t0.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE 447 TANK INTERIOR LNNG ❑ 1.RUBBER LINED ❑3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED OR COATING ❑99.OTHER (Check one item only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ® 6 UNLINED (For local use only) 449 OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For foal use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE Occal use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Checkall that apply) X I SPILL CONTAINMENT 1996 ❑ I ALARM Xv3 FILL TUBE SHUT OFF VALVE flSt`[�2 DROP TUBE ❑ 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.) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 IF SINGLE WALL TANK(Check all that apply) (Check one item only) ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE E] I VISUAL(SINGLE WALL IN VAULT ONLY) ❑3 CONTINUOUS ATG ❑ 7 GROUNDWATER X2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERTMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 4`7 gallons ❑Yes ❑ No UPCF(12/99 revised)