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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (Two pages per tank) Page_I_of_2 TYPE OF ACTION ❑ I.NEW PERMIT ❑ 4.AMENDED PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Chink one item only) ❑ 3.RENEWAL PERMIT _signaum.fowner ❑ 7.PERMANENTLY CLOSED ON SITE (speelfi moon) (spwfy mssm) ❑ S.TANK REMOVED BUSINESS NAME(Semea.FACILITY NAME.,DBA-Wi,Bonino,As) 3. FACILITY ID: 1. GI Truckng Company dba Estes West LOCATION WITHIN SITE(Dpemm) 431. 1.TANK DESCRIPTION (A scaled Plot plan With the location of the UST astern including buildings and landmarks shall be submitted to the local agency.) TANK ID# 432. TANK MANUFACTURER 433- COMPARTMENTALIZED TANK ❑Yes Z No 4E4. If"Yes. complete one page fm each comparlmml. DATE INSTALLED 435, TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 (YEAR/MO) 1999/May 12,000 1 ADDITIONAL DESCRIPTION(Folbd use Dory) 4314 Il.TANK CONTENTS TANK USE 439. PETROLEUM TYPE oar. ® 1. MOTOR VEHICLE FUEL ❑Ia. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL OfcheckQ complete Petroleum Tpe) ❑Ib. PREMIUM UNLEADED ®3. DIESEL 06. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME(from Hivardote Materiels lncmton page) -1. CAS#(ham Hwmdous Materials ln.mton page) a2. ❑ 4. HAZARDOUS WASTE (Ind Wes Used Oi0 ❑ 95.UNKNOWN 111.TANK CONSTRUCTION TYPE OFTANK ❑ L SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443_ (Check one item only) MEMBRANE LINER 095. UNKNOWN ®2. DOUBLE WALL [14, SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-prinun lank ❑ 1. BARESTEEL ®3. FIBERGLASS/PLASTIC 5. CONCRETE 0 95.UNKNOWN 444. (Check me itenoih) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary lank 0 I. BARE STEEL D9 3. FIBERGLASS/PLASTIC ❑S. FRP COMPTIBLE W/100%METHANOL 95.UNKNOWN 415. (Check one item only) ❑2. STAINLESS STEEL❑4. STEEL CLAD W/FIBERGLASS [19. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑I.RUBBER LINED 3.EPDXY LINING 0 5.GLASS LINING 0 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ®6.UNLINED ❑99.OTHER Check one tem onl OTHER CORROSION I.MANUFACTURED CATHODIC M 3.FIBERGLASS REINFORCED PLASTIC 0 95.UNKNOWN4ag. DATE INSTALLED 449, PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER (If Applicable) 2.SACRIFICIAL ANODE SPILL AND OVERFILL YEARINSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEARINSTALLED 452 (Check all that apply) ®L SPILL CONTAINMENT _May1999_ obwc2100 C3 1.ALARM ®3.FILLTUBE SHUT OFF VALVE ®2.DROP TUBE _May 1999_ obw61so [12.BALL FLOAT [14.EXEMPT ®3.STRIKER PLATE May 1999 steel IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑I. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑I.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4.STATISTICAL INVENTORY RECONCILIATION ❑R.TANK TESTING (SIR)+BIENNIAL TANK TESTING 099.OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455_ ESTIMATED QUANTITY OF SUBSTANCE REMAINING 4M- TANK FILLED WITH INERTMATERIAL? 457. gallons ❑Yes ❑ No UPCF hwftvrc-b(1/99)-1/4 http://w"m.unidoes.org Rim.02116/00