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03/17/2004 10:23 2099310,-60 CHEVRON 1580 PAGE <br />04/05 <br />I)E1D ;PROGRAM CONSOUDATEIoI >F <br />S..SINGLf WALL R'ITH INTERNAL, BLADDER SYSl'fM 4a3 <br />UNDERGROUNDSTORAGE TANKS - TANK PAGE i <br />TANKS <br />(two pages per tank) <br />TYPE OF ACTION El NEW SITE PERMIT ®4 AMENUFU PERMIT ®5 CHANGEOF INFORMATION F2p, <br />6 T1;MDORRy SITE CLOSURE <br />Page,, of 4 <br />(Check one item only) <br />-..,._-.-...__ __ ❑ 7 PERMANENTLY CLOSED ON SITE: <br />C1 4. SINGLE WALL IN VAULT <br />❑ 3 U-NFWAL PERMIT CSPccify remon - fbr locat vee only) (Specify reason - (bT lacr i use only,) © $ TANK REMOVED <br />TANK MATERIAL -primary tank BARE STEEL <br />BI,ISiNCSS NA1lvYF ($artta as FA('fLiTY NAME or DBA - Doing Business ac) <br />a30 <br />Chevron Station #99840 ; FACILITY ID; 0 0 0 1 0 1 0 0 1 0 0 0 0 <br />� <br />0 <br />LOCATION WITHIN SITE (optional) - <br />❑ 8. FRP COMPATIBLE W/100%METHANOL ❑ 99 OTHER <br />4344 Waterloo Road, Stockton C.A. 95215 <br />43t <br />L YANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted tO the local <br />Rgcncy.) <br />TANK IDN 432 ')WANK MANVFACT)lq,K a33 CONIPARTMENTALIEDED TANK Yes No <br />TANK MATERIrkt. -secondary tank [11. $AIL£ STEEL <br />2 X E RX E5 If "Yes". complete one page for each compartment, <br />434 <br />DATE- INSTALLED (YEA,It/MO) 435 TANK CAPACITY R4 GALLONS 456 NUMBER OF COMPARTMENTS <br />❑ 2, STAINLESS STEEL <br />3/12/98 15,000 0 <br />437 <br />ADDITIONAL DESCRIPTION (For local ate only) - - <br />- <br />REINFORCED PLASTIC (FRP) <br />438 <br />II, TANK CONTEN'D'S ---- <br />TANK USE 4.ry PETRO Lki)NI'TYPI <br />1. MOTOR VEHICLE FUEL ElIa. REGULAR VNLEADI;) 0 2. LOADED ClS. JET FUEL <br />4410 ' <br />(ff market/ complete Petroleum Type) 0 1b PREMIUM UNLEADED 0 3. DIESEL ❑ 6, AVIATION F1 IFI. <br />❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ®6 UNLINED <br />1:12. NON-k'U'.LPETROLEUM ❑ lo, M,IDGRADE UNLEADED ❑ 4. GASOHOL 0 99. OTHER <br />❑ 3. CHEMICAL, PRODUCT COMMON NAME (from 8aeardote Materials 1ryYertory page) 441 C:AS9 (from klata'dous Materials Inventory page) <br />� 442 <br />4. HAZARDOUS WASTE <br />(includes OsFdOil) SUPREME LNLEADE® $o�-� 1'9 <br />l 9S. UNKNOWN <br />IkI. TANK CONSTRUCTION <br />TYPE OF TANK <br />[] 1 • SINGLE WALL <br />❑ 3. SINGI.F.; WALL WI H <br />S..SINGLf WALL R'ITH INTERNAL, BLADDER SYSl'fM 4a3 <br />(::heck one tram only) <br />FXTER10R MEMBRANE LINER <br />❑ 95. t)NKNOWN <br />02, DOIMLF.. W.ALI, <br />C1 4. SINGLE WALL IN VAULT <br />❑ 99. OTHISR _ <br />TANK MATERIAL -primary tank BARE STEEL <br />3. FIBERGI..ASS!PLASTIC <br />[]5. CONCRETE 95. UNKNgWN add <br />(Check one it¢mo.ty) <br />2. STAINLESS STEED, <br />E14. STEEL CLAD W/FIBERGLASS <br />❑ 8. FRP COMPATIBLE W/100%METHANOL ❑ 99 OTHER <br />REINFORCED PLASTIC (FRP) <br />TANK MATERIrkt. -secondary tank [11. $AIL£ STEEL <br />M 3. FIBERGLASS /PLASTIC <br />❑ 5. (:nNC.RETE 95. UNKNQY 445 <br />(Check one item Only) <br />❑ 2, STAINLESS STEEL <br />❑ 4. STEEL CLAD W/FIBERGLASS <br />[IS. FRP COMPATIBLE W/100% METHANOL ❑ 99. OTIiFR <br />REINFORCED PLASTIC (FRP) <br />❑ 10. COATED STEEL <br />0 5. CONCRETE <br />TANK INTERIOR LINING <br />[011 - RUBBER LINED ❑ 3. EPDXY LINING5• GLASS LINING ❑ 9S. UNKNOWN aao DATE IN5TAl.LF;D 447 <br />OR COATING <br />❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ®6 UNLINED <br />0 99 OTHER <br />((:heck one item only) <br />OTHER CORROSION Ill MANUFAC IPFO CATUODIC 0 3 FIBEPCLASS REINFORCED PLASTIC ❑ 95 UNKNOWN aa9 <br />PROTECTION 1F APPLICABLE PROTECTION 1714 IMPRESSED CURRENT 0 99 OTHER <br />(Chock one item only) ❑ 2 SACRIFICIAL: ANODE <br />SPU • AND OVERFILL YEAR INS 1-AI.LED'---4� TYPE. (Ineai ..so onl)') 451 OVERFILL PROTECTION EQUIPMENT:7EP <br />'Check $1 h l I ) <br />(Nor 10091 me only) <br />m 449 <br />(For local Use only) <br />5 c a appy ® 03 FILL, TUBE SHAT OFF VA.[..Vf. I SPILL CONTAINMENT ] 99R <br />❑ 1 ALARM � PNV LI -SQ -4 <br />2 DROP TUBT OP W 0 2 UALI, FLOA 1 _ ❑ 4 EXEMPT <br />® 3 STRIKER PLATE _ in Tank TaIT Mf _ <br />---_„-„ _ IV. TANI( LEAK DETECTION (.A description of the monitoring program Shall be submitted to the local sgency.) -� v <br />IF SINGLE WALL TANK (Check all that apply)r�. 03 If DOUBLE WALL TANK OR TANK. WITH BLADDER <br />❑ 1 VISUAL.. (EXPOSED PORTION ONLY (Check IS only} <br />� 5 MAN(JAI,'I�ANK GAUGING (M'I'(i) ❑ ] VISUAL (SINGLE WALT, IN VAULT ONLY) <br />Irl 2 AUTOMATIC TANK GAUGING (ATG) 13 6 VADOSE ZONE 0 2 CON 11NUt)()5 INTERSTITIAL MONITc.)R)NCi <br />11 .3 (-nNFINUOUS ATG ❑ 7 GROUNDWATER ❑ 3 MANUAL MONITORING <br />❑ 4 STATISTICAL INVENTORY RECONCILIATION 0 8 TANK TtSTING <br />(SITE) SIENNIAL TANK TESTING _ 0 99 OTHER <br />IV. TANK CLOSURE INFORMATION / PERMANENT Q,01 I1JTRE IN PLACE: <br />EST(MA'TED DATE LAST USED (YR/M0/`DA Y) ass ESTIMATED QUANTITY OF SUBSTANCE, REMAINING 450 TANK PILLED WITH IN1:RT MA'T'ERIAL'? 45 <br />valloris D Yes No <br />UPC7 (1 /99 mviscd) 17.5 FormeHv SWP,(: B F'ol'1Ta R <br />