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12/19/2002 16: 27 2054683433 FIFTH FLOOR rout nz <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANK$ <br /> UNDERGROUND STORAGE TANKS—TANK PAGE I <br /> TYPE OP ACTION ❑1 NEW STTS PERMIT O 4 AMENDED PERMIT ❑ 3 CHANCE Of NPORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> I (Ci,ekaukrn"W K7 PERMANENTLY CLOSED ON SITE 'VII <br /> C3 3 RENEWAL PERMIT (Sealy mann.We beo:we wNy3 ISp,ary m,en-M19g1 ue nNy] E TAVKREMOVPD ,!0 <br /> BUSINESS NAME oiA u FACKIIY HALO mDBA-[A tRuems M) FA ILI f-til LOCATION WITHIN STM 9DeaPNeO O' <br /> 1_ 10 <br /> TANK DESCRIPTION (A 9eUed 9bt PTRR with the 10EXIbm aithe UST sy9telD iwkdiEt b9ildint7 End IBnd3n9rkR 9L611 be submitted to tbo laal RB4I14y,) <br /> TANK TDM yy�� <!= TANK MANUFACTURER COMPARTMENTALIZED TAMC Yd No 421 <br /> bft W TL hb lJ fl Y«",nae9hKes999e Poree ncompvme <br /> DATE INSTALLED(YEAR/MO) ' TANKCAPACRY AN OALIDNS 4>s NUMBER OF COMPARTMENTS aT <br /> L' <br /> UnKh Wit \�w <br /> ADDITIONAL DPSCRIPTION(vml9el wa mbl +!s <br /> LL TANK CONTENTS <br /> TANK USE 2M PETROLEUM TYPE °w i <br /> 1. MOTRt VERCLE PUSL Ird In. RECULAK UNLEADED O L LEADED p 3. !ET FJEL <br /> Ir •�9:e.9amlenm Ty9H Ij lb. PREMIUM UNLEADED C]1.DIESEL C 6. AVIATION NEL <br /> [32. NON•PUBL PETROLEUM p I4. MIDGRADE UNLEADED C34 GASOHOL C 99.OTHER jiftKA {ti <br /> C3 S. CHEMICAL PRODUCT COMMON NAME l ro n 6® Mmkh lnwnmy RET CAS#tEwnRswJnr Nwwbm Nwaay Pgn 7 <br /> A. WARDWS WASTE <br /> (muae,uwab � ' <br /> LNIwowN <br /> III, TANK CONSTRUCTION <br /> TYPEOFTANK t. WALL !. A7TH 9. SINGLE INTERNAL BLADDER EYET <br /> {Clea e.e wm.nyl EXTERIOR MEMBRANE LINER 9S. LNIWOWN <br /> ❑2. DOUSLEWALL 04. SIONLE WALL IN VAULT C3 90.OTHER <br /> _an ,ry I. SAKE STE ). RBfrtGf.A31 tL 7. CONCRETE 93. UNKNOWN ,w <br /> Khwl ms M1m 9nlyl EI2. STAINLESS STSEL C34. STEEL CLAD WlPSBRCLASS pR PRPCOMPTIBLEW1100Ya METHANOL 0799.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TAVKMATERIAL-AwmftwZ I.RARESTEEL 7. fl R LASSi PLASTIC 3. CONCRETE 97. UNKNOWN <br /> 4i3 <br /> (Gmk wlam mlYl p7. STAINLESS STEEL ❑4, STEEL CLAD WRIBERGLASS 05. FRPCOMPTI6LBWy100AMETHANOL C399.unin <br /> KEMRCED PLASTIC(1") ❑Id.COATED STEEL <br /> p9. CONCRETE <br /> TANlL INTE0.1OR L NTNGL BER LOVED 3. LINING !. LAB 95.UNKNOWN A A4LFD ++ <br /> ORCGATING p2 ALKYC LINING C3LPIIENOLICLINNO 06UNLINED 0 9 OTHER y evelw,M7 <br /> (t2.et are Ren 9NYi (m <br /> 4J8 .a <br /> DTHG CORROSION pIMANLRACTDRERG <br /> ED CATHODIC ❑7PTGLA5I REINFORCED PLASTIC 9oy".pS LRYKNOWN "ATEMMA <br /> ALLED <br /> PROTECTIUN IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑490THER (Fn hr,„acuity) <br /> toa4kesaennr9y7 ❑2 SACRIFICIAL ANODE <br /> SPILL AND OVERALL INSTALLED450 T'PECe ,..,Iy) 451 OVERFILL PRCTECTIO� Q I YMNEAR INSTALLED An <br /> (Dent.11W- ey) p I SPILLCONTAEVMENT ❑I ALARM ❑3 FILL TUSE SHUT OW VALVE <br /> ❑2 DROP TUBE ❑2 SALL FLOAT ❑4 EXEMPT <br /> ❑3 STRIKER PLATE <br /> N.TANK LEAK DETECTION(n4weYbl'm 9IVy:m9niamp Pa9genu ami ee sol dwd wtk Iml,p..rd <br /> IF SINGLE WALL TANK ,wbl IF DOUBLE WAIL TANK biL TANK WITH BLADDER AAA <br /> W kens fm.” <br /> C3 l viliu L%XrOSED PORTION OM.YI ❑3MAWAL TANK GAUCINO(MTC) I VISUAL(SNGLE WALL N VAULT ONLY) <br /> p2AUTOMATICTANK GAUGING(ATO) ❑6VAGOSEZONE C32CONlTNTOUSINTERSTITALMONTTORNG <br /> p3WN17NJDUSATG C31OROUND'WATER ❑3MANUAL MONITCRING <br /> p6STATISTICAL NVENTORYRECONCILIATION ❑B TANKTSSTNC <br /> (SIR) BIENNIAL TANK I-ES71NO ❑99 OTHER <br /> N.TANK CLOSURE INFORMATION!P£RMA VENT CLOSURE IN PLACE <br /> _ v n <br /> ESTIMATEDOATE USED(Y➢JMO/DAYt MWATEDOUAN�N OF SUBSTANCEEEREMANNG 4 uANEFI L D WITH INERT M�ERIAL. <br /> =X <br /> b e eaLr i'Ie tj <br /> G?CF(13199 revised) Formerly SWRCB Fom 0 <br />