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r... TANK 9A Ul`t.ED PROGRAM CONSOLIDATED FORD 1 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 ++meq/4/p lit) TYPE OF ACTION IJ'I NEW SITE PERMITpaBa or ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chat one itan Doty) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify mown-cur kcal use onty) (specify resent-fin kol use only) ❑ S TANK REMOVED \.% 430 BUSINESS NAME(Sun SAFEWAY FUEL CENTER #1769 3 LOCATION WITHIN SITE(Dp0ona) 431 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# p T(S �5-'� 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes ❑ No 434 1769-2 MODERN WELDING IF"Ys**%compleee one Peg,for each mmerhnent DATE INSTALLED(YEAR/MO) 431 TANK CAPACITY M GALLONS 43a N ER OF COMPARTMENTS 3/1/01 28;pOp a" ADDITIONAL DESCRIPTION(For kcal use only) 2 439 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 . MOTOR VEHICLE FUEL ❑la REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ifmarkw cmnpkm Pmolutm Type) ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM 12 Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99. OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (sum Hezudms Matonsls Inventory pege) Mt CAS#(from Heurdmk Matwal,inventory page) .t42 ❑4. HAZARDOUS WASTE Hoawe IA<a ai) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK U 1. SINGLE WALL 0 3. SINGLE WALL WITH 5. SINGLE.WALL WITH INTERNAL BLADDER SYSTEM 43 (Checkon<itrmmty) EXTERIOR MEMBRANE LINER 095. UNKNOWN M. DOUBLE WALL ❑4. SIGNLE WALLIN VAULT ❑99. OTHER_ TANK MATERIAL-primary=it IN 1. BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE '95. UNKNOWN 444 (Check one Item only) 02. STAINLESS STEEL 64. STEEL CLAD W/FIBERGLASS 0 I FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL- secondary tank I. BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE 95:UNKNOWN ass (Ch<ckonelkmmly) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPTIBLE W/100%METHANOL 099.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL N/A ❑5. CONCRETE TANK INTERIOR LINING 0 1.RUBBER LINED 3.EPDXY LINING Ll 5.GLASS LINING 95.UNKNOWN aa6 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING 0 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Chat one hem only) (For bcel use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 449 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check ore,nem only) ❑2 SACRIFICIAL ANODE (Forbulweonty) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE 0ueal ueeonty) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chnekslldutpply) X$1 SPILL CONTAINMENT 2001 5 GAL. BUCKET 0 ALARM _ KI 3 FILL TUBE SHUT OFF VALVE_ U2 DROP TUBE 200- K overfill Val e02 BALLFLOAT 0 EXEMPT 9;3 STRIKER PLATE 20M 2LATR IV.TANK LEAK DETECI70N(A dumipdos orrhe mmroriog program shaft be submiuN in the lod agency) IF SINGLE WALL TANK(Clwckae that apply) 453 1F DOUBLE WALL TANK OR TANK WITH BLADDER 454 (cheek one ttem onty) ❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG). ❑I VISUAL(SINGLE WALLIN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE M0 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑STANK TESTING (SIR) BIENNIAL TANK TESTING 0 9 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? 417 gallons ❑Yes ❑ No '1111I