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�IrFIED PROGRAM CONSOLIDATED FORNee, TAN <br /> UNDERGROUND STORAGE TANKS -TANK PPAGE I a <br /> (Ma pages per tank) <br /> Page � or <br /> ❑ 8. TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT . GUNGE OF INFORMATION) T PERMANENTLY CLOSED ON SITE <br /> (Check one item°MY) <br /> Cl 3.RENEWAL PERMIT (SP.-ymason-brlpcN uta aMY) (Spx/ycherpe-Mlouluse onlYl ❑ B. TANK REMOVED 030 <br /> 1 <br /> BUSINESS NAME(Swm+s//F{{AC''ILITY NAME w DBA-�Doe�q B�uJyw��sa Alk) <br /> FAOIUTY ID Y <br /> LOCATINWTHINSITE(CAdono 431 a - - T V <br /> 1.TANK DESCRIPTION <br /> TANKMANUFACTURER COMPARTMENTALIZED TANK ❑ Yea No <br /> TANK IDY <br /> r1 II Yat,complete one 11a for eaN-m ItOn em. <br /> DATEINSTALLED(YFA <br /> TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> � WMO)- DOD <br /> ADDITIONAL DESCRIPTION(F II`efuw <br /> It.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE ❑ 5. JET FUEL <br /> ❑ 1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑ 2. LEADED <br /> (p ma Med.oompbb PvVoIe.Type) ❑15. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 8. AVIATION FUEL <br /> ❑ 2. NONFUEL PETROLEUM ❑ 4. GASOHOL . OTHER <br /> ❑Ic. MIDGRADEUNLEADED <br /> [33.CHEMICAL PRODUCT CABF(/mmHmIEWZ Mabnals In tory p+9e) <br /> COMMON NAME(hom Hazardous Mebrialz Inwnfory papa) <br /> ❑ 4. HAZARDOUS WASTE(Moludes <br /> Umd Od) <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK SINGLE WALL Cl 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> EXTERIOR MEMBRANE LINER 1195 UNKNOWN <br /> (Check 9na de-only ❑ 2. DOUBLE WALL 0 4, SINGLE WALL IN A VAULT [1 99, OTHER <br /> TANK MATERIAL-pdmarl Mnk <br /> BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> 100%METHANOL OTHER <br /> (Check omits.only) ❑ 2. STAINLESS STEEL ❑4. REINFORCED PUSTEEL CLAD ISTIC(RPS 0 e. FRP COMPATIBLE W/ 89. <br /> TANK MATERIAL-eerondary Mnk [I 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE W/iW%METHANOL 095. UNKNOWN <br /> (Check one dem onlyl ❑ 2. STAINLESS STEEL 0 4, STEEL CLAD S . CPNON-CORRODIBLE JACKET 099. OTHER <br /> REINFORCED PLASTIC(RP0ID <br /> ❑ 5. CONCRETE <br /> DATEINSTALLED <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXYLINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 <br /> OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ S. UNLINED ❑99. OTHER <br /> DATE IN used <br /> (Check om dom on PATE INSTALLED <br /> OTHER CORROSION 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWNN� �,I4M <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT AS. OTHER ALal - (fyl luyl u��,,�w111 any) <br /> (Oheck om"m only ❑ 2. SACRIFICIALANODE OVERFILL PROTECTION EQUIPMENT'.YEAR INSTALLED al' {µ <br /> SPILL AND OVERFILL A. YEAR INSTALLED TVPE(Forlxa/ws ony) 'V e l <br /> (Check all Mal apply) ❑ 1. SPILL CONTAINMENT ❑ 1, ALARM - Cl 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALL FLOAT_ ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> N. TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER Check one Item om <br /> IFSINGLEWALLTANK Checkakfhel• <br /> ❑ [35. MANUAL TANK GAUGING(MTG) 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ' <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ e. VADOSE ZONE <br /> [13. CONTNUOUSATG ❑ T. GROUNDWATER ❑ 3. MANWLMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION ISM) ❑ 8. TANKTESTING <br /> BIENNIAL TANK TESTING 99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE UST USED(yRBAOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br /> 435 1 TANK FILLED WITH INERT MATERIAL) <br /> gallon. ❑Yee No �7 <br /> 5 3 00 <br /> 1 � 1� Forrnerly SWRCB Form B <br /> CUPAFORM(4199) \J <br />