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' D PROGRAM CONSOLIDATED F YAQ PW qA-V TANKS UNDERGROUND STORAGE TANKS - TANK RAGE 1 s 1,9- (two Pages Per tank) Page�Zc JI .TWE OF ACTION ❑1 NEW SITE PERMIT ® 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Cl,cols one km only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for kcal we only) (Specify rowers,-for local we only) ❑ 8 TANK REMOVED 430 --L BUSINESS NAME(Smew PACIIJTY NAMam DBA-Doing aware.As) 3 FACILITY ID: Van De Pol Ent rises LOCATION WITHIN SITE(OPtioneo 47l 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#3 432 TANK MANUFACTURER 433COMPARTMENTALIZED TANK Yes No 434 UNKNOWN TAO 3�l`oZO UNKNOWN H•Yes,agleernePaBeaaan<oWanma DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1988 12,0Co 1 ADDITIONAL DESCRIPTION(For kd we only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 040 ❑,1. MOTOR VEHICLE FUEL Ela. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (Irmerk complem Pearokmm Type) ❑lb. PREMIUM UNLEADED [13. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑10. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (6om llaardow Maaws lrrsawo y age) 441 CAS#(fora Haaardow Materials Inventory page) 442 04. HAZARDOUS WASTE UNKNOWN (Include Used oil) [195.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 0 3. SINGLE WALL WITH 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chckomhemonly) EXTERIOR MEMBRANE LINER 095. UNKNOWN 02. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-prim twk ❑I. BARE STEEL 03. FIBERGLASS/PLASTIC [13. CONCRETE 0 95. UNKNOWN 443 (Chock one am only) ❑2. STAINLESS STEEL [34. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/loOY.METHANOL ❑99.OTHER REINFORCED PLASTIC TANK MATERIAL-secondary tank 1. BARE STEEL ®3. FIBERGLASS/PLASTIC 0 5. CONCRETE ❑95. UNKNOWN 445 (Chock om dem only) [12. STAINLESS STEEL [34. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%.METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED 0 3.EPDXY LINING ❑5.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 1816 UNLINED ❑99 OTHER (Check ane w,rn.Iy) (For local we only) OTHER CORROSION ❑ [MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN us DATEINSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER (Check om hem only) ❑2 SACRIFICIAL ANODE (Fm local we only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(loaf as.only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Cheek all that sqly) ®1 SPILL CONTAINMENT 2003 01 ALARM 2003 ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 0 2 BALL FLOAT 2003 ❑4 EXEMPT ®3 STRIKER PLATE 1988 IV.TANK LEAK DETECTION(A description oftba rmnhoring pmgran shall be submitted m the local asswer) IF SINGLE WALL TANK(clnck 41 tho,apply) 053 IF DOUBLE WALL TANK OR TANK WITH BLADDER 03a (Clack oro kemonly) ❑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 LED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED(YR/MO/DAY) 655 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FIL gallons ❑Yes [I No UPCF(12/99 revised) 10 Formerly SWRCB Form B