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D PROGRAM CONSOLIDATED F D" j TANKS UNDERGROUND STORAGE TANKS - T AGE J! 3 (two pages per tank) Page 77 7 TYPE OF ACTION [I1 NEW SITE PERMIT ® 4 AMENDED PERMIT [:15 CHANGE OF INFORMATION [36 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE (Check.item only) ❑ 3 RENEWAL PERMIT (8paify awn-forbcel 000nly) (Spai[y reuov-krloW uae only) ❑ S TANKREMOVED 430 F BUS INE$$NAM E(s.meuFAQLITY NAME mDBA-Doing ausineu M) 3 ACILITY ID: I- - _ _ _ _ Van De Pol Enterprises 431 LOCATION WITHIN SITE(optbna) Northwest side of site 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.) TANK ID# A 012 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 UNKNOWN T40035.90 UNKNOWN )f" .-,conplae one Page for each oomPanmem. DATE INSTALLED(YEAWMO) 01S TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1988 'LQOOO 1 ADDITIONAL DESCRIPTION(Fa low.only) 439 Q.TANK CONTENTS TANK USE 639 PETROLEUM TYPE 600 (Ll. MOTOR VEHICLE FUEL ❑Ia. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL nfmarkedcomplex Pmakwn Type) [3 1b. PREMIUM UNLEADED 5L3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED [14. GASOHOL ❑99.OTHER [13. CHEMICAL PRODUCT COMMON NAME (from Bazadow moonnlls Invmtn y pose) 461 CAS#(from Haoardmu Muen th lo-tory page) d62 ❑4. HAZARDOUS WASTE UNKNOWN paluda u.w od) [195.UNKNOWN ILL TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL ❑3. SINGLE WALL WITH El 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 43 (chew one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN ®2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-prinurymnk 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC ❑5. CONCRETE 0 95. UNKNOWN 444 (CTeck one Item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTICFRP TANK MATERIAL-aaondary tank 1. BARE STEEL ®3. FIBERGLASS/PLASTIC 5. CONCRETE El 95. UNKNOWN 445 (Chale orx item only) ❑2. STAINLESS STEEL [34. STEEL CLAD W/FIBERGLASS [18. FRP COMPIIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑ lo.COATED STEEL ❑S. CONCRETE TANK INTERIOR LINING Ll 1.RUBBER LINED ❑3.EPDXY LINING 5.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Chat oro item only) (For local ux only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 668 DATE INSTALLED 409 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT - ❑99 OTHER (check one item only) ❑2 SACRIFICIAL ANODE (For local no:only) SPILL AND OVERFILL YEARINSTALLED 450 TYPE(bml ow only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chale all than apply) ®I 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 description of Ne anitonng pmgxm"I Ix subm0ted to the low agency.) IF SINGLE WALL TANK(chak all that appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 450 (Calc one hem only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑I VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE TONE ®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) d55 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 057 gallons ❑Yes ❑ No UPCF(12/99 revised) 10 Formerly SWRCB Form B