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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Aw Pages W Mme) <br /> P." <br /> TYPEOFACTION ❑1.NEWSITE PERMIT ❑ 4.AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) ❑ a. TEMPORARY SITE CLOSURE <br /> ICck..aNW ❑ 7. PERMANENTLY CLOSED ON SITE `'p <br /> ❑J.RENEWAL PERMIT (SPM�YM3M,bbtNuN Myr (SPFr/y Nunpa blecalvu sOM TANK REMOVED 430 V I <br /> BUSINESS NAME(Sana n FACILITY NAME aDBA-D"Bvvru AM - FACILITY100 1 <br /> San Jo VQ tvr I s 3 <br /> LOGTIOH WTION SITE(ODBHa0 431 <br /> I.TANK DESCRImON <br /> TANK IDa TANN MANUFACTURER COMPARTMENTALIZED TANK ❑ Y16 ❑ No <br /> It MaF.COmPIaN PM PaW bash CpnpaNnaM <br /> PATE INSTALL��D(nY�A TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> Y L <br /> AOgTK)NAL DESCRIPTION(FnAX:MaM aNY) <br /> K TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1 MOTOR VEHICLE FUEL ❑Ta. REGULM UNLEADED ❑2.LEADED ❑ 5. JET FUEL <br /> rymaHwB.Cany.4FHPWPWaP 77PN ❑Ib PREMIUM UNLEADED ❑ 3. DIESEL 0 AVIATION FUEL <br /> ❑ 2. HON-FUELPETROLEUM ❑Ic MIDGRADEUNLEADED ❑ 4.GASOHOL 0 T OTHER <br /> ❑ 3 CHEMICALFRODUCT C52MON NAME(Mm Ha2ampV3 MaNMIII NWMWPK?-) CAS/(M1wn Huartlpua MaMNls ln.en;pry page) <br /> Q 4 HAZARDOUS WASTE(IrMuaaF <br /> UMKI Oq <br /> IS uWR:AVN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 0SINGLEWALL ❑ 3.MRGLE WALL WITH 05. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> ([MCLem lam arVF) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> ❑4.SINGLE WALL IN A VAULT 0BO.OTHER <br /> TANK MATERAL-PlIFMy 0 1 BARE STEEL ❑ 3. FIBERGLASSIPLASTIC ❑ S CONCRETE ❑95. UNKNOWN <br /> (CAFCMOrH IMa alyi ❑ 2. STAIWESSSTEEL 04. STEELCLADWFIBERGLASS ❑ 8 FRPCOMPATIBLEWI00%METHAMOL ❑99.OTHER <br /> REINFORCEDPUASTIC FRP) <br /> TANKMATERAL-vocWd"UM 0 1 BARE STEEL O 3. FIBERGLASSIPUSTIC ❑ 0. FRPCOMPATIBLEWIUO%METHANOL 095. UNKNOWN <br /> (CHEM arN dm oNy) ❑ 2. STAINLESS STEEL ❑4.STEELCLADWFlBEROUSS ❑ 9.FRPNONSCORROOIBLEJACKET ON. OTHER <br /> REINFORCED PLASTIC(FRP) 010 COATED STEEL <br /> ❑ 5.CONCRETE <br /> TANK INTERIOR LININGDATEINSTALLEO <br /> OR CQATING ❑ 1.RUBBER LINED ❑ ]. EPO%Y UNItq ❑ 5 GLASS LINING 095. UNKNOWNtl3 <br /> ❑ 2.ALKYO LINING ❑ 4.PHENOLIC UNINO ❑0. UNLINED 099 OTHER (Po(NFMup <br /> YerII MO PATE INSTALLED <br /> OTHER CORROSION ❑ 1.MANUFACTURED CATHOVC ❑ 3. FlBERGLASS REINFORCED PLASTIC 095 UNKNOWN 4N <br /> PROTECTNKIIFAPPUCABLE PROTECTION <br /> ❑4. IMPRESSED CURRENT ❑99. OTHER (FpbcM va OMy) <br /> (DaaFA.lam ow ❑ 2 SACRIFICAL ANODE <br /> SPILLANDOVERMLL YEAR INSTALLED WPE(F.IMM uw oMq OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> FMCLYNFtaNM ❑ 1. SPILL CONTAINMENT ❑ 1.ALARM __ ❑ 3. FILLTUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2 BALLFLOAT_ ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> N.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK MIM(• iDOUBLE WALL TANI(OR TANN WTH BLADDER rMilam <br /> ❑ 1. VISUAL(EXPOSEOPORTKM ONLY) ❑ S MANUAL TANK GAUGING INTO) 1. VI$U.]L(SINOLEWALLIHVAVLTONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSEZONE ❑2. CONTINUOUSBNERSTITIALMO TORING <br /> ❑3. OONTINUOUSATG ❑ T. GROUNDWATER ❑ ]. TAANUALMOMTORING <br /> ❑4. STATISTICAL INVENTORY RECONCILIATION(WR)a ❑ B. TANK TESTING <br /> EIEHWAL TANK TESTING 099 OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTMATEDOATELASTUSED(YFUMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERAL7 <br /> 94kmA ❑Yaa ❑NP <br /> el <br /> Ft 1 1w'LC Lti 7, j z.�� L7_mz <br /> C L'- l4 YUC a- <br /> CUPAFORMJ"g) - [Tt'c^lL (C?•7,'Lx_Y If ; �'C1« LLA pDINIeM srmcR Foml e <br /> .. 4�LLk, it <br />