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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 p <br /> (two pages p ytwk) <br /> Pape >2- <br /> TYPE <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE <br /> (CMckornkemow ❑ ?. PERMANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT (Spxiy reason-brbcN uss qtly) (Spstlychanpe-Mhwluse onM ><B. TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-DNop Business As) FACILITY ID 1 <br /> LOCATION VMIN SITE(OP9ona9 431 <br /> I.TANK DESCRIPTION <br /> TANK IDN ///��3 TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes o <br /> L 6 g a I 11'Yea',complaro ons papa br eaU camparlmenl. <br /> DATE INSTALLED(YEA 6 v TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> G� Ldurvv / 660 <br /> ADDITIONAL DESCRIPTION(Farlpaid use only) - <br /> 11.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL ❑la REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (pmaAM,complero PNmbum Type) 1:11D. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 5. AVIATIONFUEL s <br /> X2. NOWFUELPETROLEUM 010 MIDGRADEUNLEADED ❑ 4. GASOHOL W. OTHER WQ/O fe- <br /> ❑ 3. CHEMICAE COMMON NAME(hpm Nazarepua MaroNls lnuvnferypapeJ C SN(Spm Hazadous Matedalslmenfoypa ) <br /> ❑ 4. HAZARDOUS USWAS WASTE(ImA.dss <br /> uaW o;p <br /> (7195 uNKNcvmN <br /> Ill.TANK CONSTRUCTION <br /> TYPE OF TANK 1, SINGLE WALL ❑ 3. SINGLE WALL HATH ❑ 5. SINGLE WALL WITH INTERNAL BLADOER SYSTEM <br /> (Chectone RenroNy) ❑ 2. DOUBLEWALL EXTERIOR MEMBRANE LINER 1:195. UNKNOWN <br /> ❑ 4. SINGLE WALL IN A VAULT 1199. OTHER <br /> TANK MATERIAL-ptlmary lank _X1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> (Check mM dem orxy) ❑ 2. STAINLESS STEEL ❑4. STEEL CIU)WIFIBERGIASS ❑ B. FRP COMPATIBLE W1100%METHANOL 13 99 OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIV8,? dory lank 0 1 BARE STEEL 133. FIBERGLASS I PLASTIC ❑ S. FRP COMPATIBLE WtlW%METHANOL 095. UNKNOWN <br /> fC korudemmay)/•; ❑ 2. STAINLESS STEEL ❑ l STEELCIADVORBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) [110. COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNMOWM433 DATEINSTALLED <br /> OR COATING .g.-./g <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING I UNLINED ❑99. OTHER <br /> ChxM madam ) (FPrlpcal use <br /> OTHERCORROSION ❑ 1. MANUFACTURED CATHODIC 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 4N DATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION �,� A��-y1 <br /> ❑ 4. IMPRESSED CURRENT 1X59. OTHER / !l /_ <br /> (Check oro dam oMy) ❑ 2. SACRIFICIALANODE (Forbcaluss Dory) <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Fmlocalussorly) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED Al <br /> 4 <br /> (CNCk ad that apply) 0 1 SPILL CONTAINMENT ❑ 1. ALARM 3. RLL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. SALL FLOAT 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> -1V.TANK LEAK DETECTIONI <br /> IF SINGLE WALL TANK Check 0 ffetpW IF DOUBLE WALL TANK OR TANK WITH BLADDER heck one Xemm : <br /> ❑ 1. VISUAL(EXPOSEO PORTION ONLY) MANUAL TANK GAUGING(MTG) ❑ 1. VISUALISINGLEWALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ B. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)♦ ❑ e. TANKTESTING <br /> BIENNIAL TANK TESTING 0 OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED9(YRA10/DAY) ESTIMATED OUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED NRH INERT MATERIAL? <br /> q pallma ❑Yes )(Ne <br /> 6-30 , <br /> CUPAFORM(4199) �Paalo, %sse, Formerly SWRCB Form 8 <br />