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FIED PROGRAM CONSOLIDATED FORM TANK: TA0140405 <br />PR #: PRO231404 <br />UNDERGROUND STORAGE TANKS - TAN 1 la' FAC #: FA0002915 <br />I (two pages per tank) <br />Page 6 of 9 <br />TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br />(Check only item only) ❑ 7 PERMANENTLY CLOSED ON SITE <br />00 tr <br />❑ 3 RENEWAL PERMIT ' - " +? ❑ 8 TANK REMOVED <br />430 <br />BUSINESS NAME (same as FACILITY NAME or DBA - Doing Business As) <br />FACILITY ID: <br />PR #: <br />1 <br />BONFARE MARKET #35* <br />3 <br />F FA0002915 <br />PR0231404 <br />LOCATION WITHIN SITE (Optionaq 15 E GRANT LINE RD, TRACY <br />431 <br />PHONE <br />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.) <br />TANK ID# Tank #: 5 432 <br />TANK MANUFACTURER 433 <br />COMPARTMENTALIZED TANK ❑ Yes ❑ No <br />434 <br />TA0140405 <br />if "Yes", complete one page for each compartment. <br />DATE INSTALLED (YEAR/MO) 435 <br />TANK CAPACITY IN GALLONS 436 <br />NUMBER OF COMPARTMENTS <br />437 <br />12,000 <br />ADDITIONAL DESCRIPTION (For local use only) <br />438 <br />II. TANK CONTENTS <br />TANK USE 439 <br />PETROLEUM TYPE <br />440 <br />® 1. MOTOR VEHICLE FUEL <br />® la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br />(If marked complete Petroleum Type) <br />❑ lb. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL <br />❑ 2. NON -FUEL PETROLEUM <br />❑ lc. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER <br />❑ 3. CHEMICAL PRODUCT <br />COMMON NAME (from Hazardous Materials Inventory page) 441 <br />CAS# (from Hazardous Materials Inventory page) <br />442 <br />❑ 4. HAZARDOUS WASTE <br />(Includes Used Oil) <br />❑ 95. UNKNOWN <br />III. TANK CONSTRUCTION <br />TYPE OF TANK ❑ I. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br />443 <br />(Check one item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN <br />® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER <br />TANK MATERIAL - primary tank ❑ L BARE STEEL ❑ FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN <br />444 <br />(Check one item only) ❑ 2. STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/ 100% METHANOL <br />REINFORCED PLASTIC (FRP) ❑ 99. OTHER <br />TANK MATERIAL - secondary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN <br />445 <br />(Chink one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/1000/. METHANOL <br />REINFORCED PLASTIC (FRP) ❑ 1o. COATED STEEL ❑ 99. OTHER <br />❑ 5. CONCRETE <br />TANK INTERIOR LINING ❑ L RUBBER LINED ❑ 3. EPDXY LINING ® 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED <br />447 <br />OR COATING <br />❑ 99. OTHER <br />(Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED (For local use only) <br />OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ® 95 UNKNOWN 448 DATE INSTALLED <br />449 <br />PROTECTION IF APPLICABLE PROTECTION <br />E] 4 IMPRESSED CURRENT ❑ 99 OTHER <br />(Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) <br />SPILL AND OVERFILL YEAR INSTALLE450 TYPE (local use only) 451 <br />OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED <br />452 <br />(Check all that apply,) ® I SPILL CONTAINMENT 1,988.00 <br />❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VAL` <br />n 2 DROP TUBE 1,988.00 <br />® 2 BALL 1,988.00 ❑ 4 EXEMPT <br />0 3 STRIKER PLATE 1,988.00 <br />FLOAT <br />IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) <br />IF SINGLE WALL TANK (Check all that apply) 453 <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER <br />454 <br />❑ I VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (MTG) <br />(Chcck one item only) <br />❑ 2 AUTOMATIC TANK GAUGING (ATG) ❑ 6 VADOSE ZONE <br />❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) <br />❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER <br />® 2 CONTINUOUS INTERSTITIAL MONITORING <br />❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING <br />❑ 3 MANUAL MONITORING <br />(SIR) BIENNIAL TANK TESTING ❑ 99 OTHER <br />V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (YR/MO/DAY) 455 <br />ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 <br />TANK FILLED WITH INERT MATERIAL? <br />457 <br />1 <br />E:] Yes❑ No <br />UPCF (12/99 revised) <br />