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D PROGRAM CONSOLIDATED FOy4 "J 1 A- j v TANKS UNDERGROUND STORAGE TANKS -TANK E 1 5 (� A_3 (two pages per tank) Page-aof u- TYPE OF ACTION ❑1 NEW SITE PERMIT N 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chat oa nanwly) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Sperily r<uon-for krwl use only) (Spxify..-forlootti.only) ❑ S TANKREMOVED 430 BUSINESS NAME(Soote w FACILITY NAh or DBA-being Bmmeeo Ae) FACILITY ID: 1 Van De Pol Enterprises LOCATION WITHIN SITE(Optionep 431 Northwest side of site L 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# 1 432 TANK MANUFACTURER 033 COMPARTMENTALIZED TANK ❑Yes 0 No 43s UNKNOWN b 35 UNKNOWN fvW.omgeemewseorboupn�nt. DATE INSTALLED(YEAR/MO) 035 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1988 L0r0cO 1 ADDITIONAL DESCRIPTION(Fm local vee only) 439 IL TANK CONTENTS TANK USE 639 PETROLEUM TYPE 6/0 5W. MOTOR VEHICLE FUEL ❑ Ia. REGULAR UNLEADED [:12. LEADED ❑5. JET FUEL (If muted wrrylea Pewlwm type) ❑Ib. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑la MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (aom Hssurdoos Mmerials Inventory page) 061 CAS#(6om Hasadow Mazaiels Inventory PnO 442 ❑4. HAZARDOUS WASTE UNKNOWN (I.W.Used Oil) ❑95.UNKNOWN Ill. TANK CONSTRUCTION TYPE OF TANK 0 1. SINGLE WALL 0 3. SINGLE WALL WITH M S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Owok one dem only) EXTERIOR MEMBRANE LINER 095. UNKNOWN ®2. DOUBLE WALL [14. SIGNLE WALL IN VAULT [199. OTHER TANK MATERIAL-primmytank 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC U 5. CONCRETE C1 95. UNKNOWN 4a.t (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPTIBLE W1100%METHANOL ❑99.OTTER REINFORCED PLASTIC FRP TANK MATERIAL-samndary took 1. BARE STEEL 129 3. FIBERGLASS/PLASTIC ❑5. CONCRETE 0 95. UNKNOWN 445 (Chat one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS [18. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING 0 1.RUBBER LINED D 3.EPDXY LINING 0 5.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Chak oou nem only) (Fm IoW use only) OTHER CORROSION ❑]MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN u9 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Chair me nem only) ❑2 SACRIFICIAL ANODE (For lowl ur only) SPILL AND OVERFILL YEAR INSTALLED 451) TYPE(locaimonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 4n (C k all tlm apply) ®]SPILL CONTAINMENT 2003 ®1 ALARM 2003 ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 ®2 BALL FLOAT 2003 ❑4 EXEMPT ®3 STRIKER PLATE 1988 IV.TANK LEAK DETECTION(A dcaiption ofthe monitoring program shell b submitted to the loWµenvy.) IF SINGLE WALL TANK(cltat ell the apply) 653 1F DOUBLE WALL TANK OR TANK WITH BLADDER 456 (Clw 1c one owroonly) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 4T1 gallons ❑Yes ❑ No UPCF(12/99 revised) 10 Formerly SWRCB Form B