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UNI,,.,,D YKUGKANI ILU1r&ULuya I 1 wnr.a <br /> �( TANKS <br /> UNDERGROUND STORAGE TANKS- TANK PAGE 1 <br /> TANK #'2-- - (twoPaS ec per r tank) <br /> P"—Lof <br /> TYPE OF ACTION ffT NEW SITE PERMIT 04AMENDEDPERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> tch4k o.4 Yew my) _ ❑ 7 PERMANENTLY CLOSED ON SITE. <br /> ❑ 3 RENEWAL PERMIT (spe ffy e.n-rwkxo.aeo•y) lspai%n -fwmd o*) ❑ R TANKREMOVED <br /> BUSINESS NAME(Sam FAcam'NAWE DBA-DoingRw. aft) FACILITYID: <br /> SAFEWAY FUEL CENTER #1769 6 <br /> LOCATION WITHIN SITE(op or) of <br /> L TANK DESCRIPTION (A scaled plot plan With the location,of the UST system including buildmp and landmarks shall be submitted to the local agency.) <br /> TANK ID#,f h OT (5 5's rl 4n TANK MANUFACTURER aJ COMPARTMENTALIZED TANK ]Yes ❑ No 414 <br /> 1769-2 MODERN WELDING f"Yu'.mmP cone P.B fw a 6 omp ron .t. <br /> DATE INSTALLED(YEARIMO) 415 TANK CAPACITY IN GALLONS 46 NUMBER OF COMPARTMENTS 417 <br /> 20,000 2 <br /> ADDITIONAL DESCRIPTION(Fw nd.ae.wr) 4A <br /> IL TANK CONTENTS <br /> TANK USE PETROLEUM TYPE 446 <br /> Ell. MOTOR VEHICLF,FUEL ❑la REGULAR UNLEADED ❑2. LEADED ❑S. JET FUEL <br /> FIT Iilm.pleePaoal.�m Tym) Ib. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION FUEL <br /> 02. NON-FUEL PETROLEUM Ic MIDGRADE UNLEADED 04. GASOHOL ❑99.OTHER_ <br /> ❑3. CHEMICAL PRODUCT COMMON NAME (awn Haz s Matma(s Invmk.y peat) i01 CAST{(aom M .N(nrrnlmy payc} M2 <br /> [34, HAZARDOUS WASTE <br /> 41 a Uzd 04) <br /> ❑95.UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK : SINGLE WALL 3. SINGLE WALL WITH S. SINGLE WALT,WITH INTERNAL eLADDERSYSTEM 44T <br /> (C6aka��,„poy,) EXTERIOR MEMBRANE LINER [3 95. UNKNOWN <br /> DOUBLE WALL [3 4. SIGNLE WALLIN VAULT 099. OTHER_ <br /> TANKMATERIAL-pswy� I. BARE STEEL 3. FIBERGLASS/PLASTIC 0 S. CONCRETE 0 95. UNKNOWN 44+ <br /> (cn y..a;m...y) [12. STAINLESS STEEL A 4, STEEL CLAD WIFIBERGLASS ❑& FRP C(M4PTIBLE W/1000y.METHANOL ❑99 OTHER— <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-srm Wb mk 0 1. BARE STEEL 3. HBEROLASS!PLASTIC ❑5. CONCRETE 0 95. UNKNOWN 445 <br /> (Ct¢kowae.o.y1 <br /> [3 2. STAINLESS STEEL ❑4. STEEL <br /> CLAD <br /> D WIFIB RGLA) O S 9 ,0. FRP <br /> DSTEEL COMPTIBLE Wf100%METHANOL ❑.99.OTHER <br /> _ <br /> REINFO <br /> N/A ❑5. CONCRETE <br /> TANK INTERIOR LINING L RUBBER LINED 3.EPDXY LINING 5.GLASS LINING 95.UNKNOWN 446 DATEINSTALLED 44T <br /> OR COATING 0 ALKYD LINING 04PHENOUCLINING ❑6UNLINED 0 9 OTHER <br /> tFor w.z..y) <br /> tcl one run ody) <br /> 41a DATE INSTALLED '14p <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC 1395 UNKNOWN <br /> PROTECITON IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER <br /> (Cb . --61y) ❑2 SACRIFICIAL ANODE (Farloaluaemy) <br /> SPILL AND OVERFILL YEARINSTALLED 456 TYPE(tod oz ony) a51 OVERFILL PROTECTION EQUIPMENTNEAR INSTALLED 452 <br /> (CTkckAIu9 pply) $j 1 SPIV.CONTAINMENT 200_1 GA . BUCKET 0 ALARM KI 3 FILL TUBE SHUT OFF VALVE2,QQ1 <br /> U2 DROP TUBE 7001, M overfill Val e[32BALLFLOAT_ ❑4EXEMPT <br /> 9;3 STRIKER PLATE -2W1 PLATE <br /> IV.TANK LEAK DETECTION(A d..;x.n ath---oo0ng p,=TANK <br /> ol..b m uK rod ageoey.lIF SINGLE WALL TANK/r.T«rt>•16ss yply) a5i WALL TANK ORTANK WITH BLADDER q54..y)❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) (SINGLE WALL IN VAULT ONLY)❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE UOUS INTERSTITIAL MONITORING❑3 CONTINUOUS ATG ❑7 GROUNDWATER L MONITORING <br /> ❑4STATISTICAL INVENTORY RECONCILIATION ❑STANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑"OTHER <br /> [V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRIMOIDAY) 055 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WFFH INERT MATERIAL? 451 <br /> gallons ❑Yes ❑ No <br />