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APPENDIX E <br /> STI SP001 AST Record <br /> Form completed by(Name) Date <br /> (Title) <br /> OWNER INFORMATION FACILITY INFORMATION INSTALLER INFORMATION <br /> Name Name Name <br /> State of California, Department of Corrections Northern California Youth Correctional <br /> and Rehabilitation Center <br /> Number and Street Number and Street Number and Street <br /> 7650 S. Newcastle Rd 7650 S. Newcastle Rd <br /> City,State,Zip Code City,State,Zip Code City,State,Zip Code <br /> Stockton, CA 95215 Stockton, CA 95215 <br /> Regulatory facility ID number(if applicable) <br /> OWNER'S TANK ID Gasoline Tank OTHER ID INITIAL SERVICE DATE <br /> Manufacturer: Fireguard Contents: Gasoline Construction Date: Last Repair/Reconstruction Date: <br /> Dimensions: Capacity: 8000 gallons Last Change of Product Date: <br /> Design: ❑ UL ❑ SwRI ❑API ❑Other ❑ Unknown <br /> ® Horizontal ❑Vertical ❑ Rectangular <br /> Construction: ❑ Bare Steel ❑Cathodically Protected(Check one:A. ❑ Galvanic or B.❑ Impressed Current) Date Installed: <br /> ❑ Coated Steel ❑Concrete encased steel ❑ Stainless steel ❑Other <br /> ❑ Double-Bottom ® Double-Wall ❑ Lined inside;Date lining installed: <br /> Spill control: ❑ Earthen Dike ❑ Steel Dike ❑Concrete CRDM: Eyes ❑ no <br /> ❑ None ®Other _double-wall If yes,type:❑ Release Prevention Barrier❑ Elevated tank ❑ Double bottom tank <br /> Tank elevated on supports ®yes ❑ no ® Double wall tank ❑CE-AST ❑other <br /> Support material: ®steel ❑concrete ❑ other <br /> Release Prevention Barrier: ❑yes ® no If yes, Date Installed: AST Category: ®Category 1 ❑ Category 2 ❑ Category 3 <br /> If yes,Type:❑concrete❑synthetic liner ❑clay liner ❑ steel ❑other <br /> AST Record E-1 <br />