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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> ( (IV�9a�I tank) <br /> Po9e _ of <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE <br /> (CMck orM Nm 111 ❑ ) MANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT (Sp..*eaaen.MMcal ua W f3pepuyaBMga-fpI uas oNy) 17K REMOVED 130 <br /> BUSINESS FUME(Sams n FACIUW NAME w OSA-Dokq Suet .A.) FACILITY 10 P 1 <br /> -Xn2> E - r� i�995 <br /> WITHIN SIT -p 31 <br /> pn ,77 \ <br /> LS-�c Ca s'Sza <br /> TANK DESCRIPTION <br /> TANK 108 TANKIA NUFACTURER COMPARTMENTALIZED TANK ❑ Vae No <br /> If'Yei.'I.w one pa9a/w eaUt paMlenL <br /> DATE INSTALLED(YFARAW) TAYK CAPACITY IN GILLONS NUMBER OF COMPARTMENTS <br /> I <br /> ADDITIONAL DESCRIPTION(Fwlaul va Dray) <br /> U.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL ❑1s. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> fff.k FpmpleM Pefmleum TYPII) ❑15. PREMIUM UNLEADED ❑ 3. DIESEL ❑ S. AVIATION FUEL <br /> ❑ 2. NDN.FUELPETROIIUM ❑1. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER <br /> HEMICAL PRODUCT COMMON NAME(Rwn Hazardous Maft I Inwmowmw OAS 5(I Nazal us M4Mdala Invsnforypepa) <br /> . UA 00TOUS WASTE(II <br /> 13 aS UNI <br /> 111.TANK CONSTRUCTION <br /> TYPE OF TANK I SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (CMck wM dam say) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOVIN <br /> ❑ 4. SINGLE WALL IN A VAULT ❑N OTHER <br /> TANK MATERIAL-p8mary lankBARE STEEL 113. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 13 95, UNKNOWN <br /> (CMck oris dem oMy) STAINLESS STEEL 0. STEEL CLAD WIFISERGLASS ❑ 8. FRP COMPATIBLE WfIW%METHANOL ❑89. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-faow 'lnk ( BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE WIIW%METHANOL ❑95. UNKNOWN <br /> (LMck maiMm Dray) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NOWCORRODISLE JACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) ❑10 COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ S. GLASS LINING 095. UNKNOWN433 DATE INSTALI45 <br /> OR COATI13 NG 2. pLIi1'D LINING ❑ 4. PHENOLIC LINING -1'Tc-o./ ❑ / <br /> UNLINED 99. OTHER <br /> (CA k.dsm <br /> OTHERCORROSION ❑ 1 MANUFACTUREDCATHODIL ❑ 3. FIBERGLASS REINFORCED PLASTIC 95, UNKNOW44 431 DATE INSTp!I cn <br /> PROTECTION IF APPLICABLE PROTECTION ���� <br /> ❑ 4. IMPRESSED CURRENT ❑�. OTHER (Fwlzaluaepr9tg <br /> (CAeclt wla ifern way) ❑ 2. SACRIFICIAL ANODE <br /> SPILLANDOVERFILL YEAR INSTALLED TYPE(Fwbul ua4 say) OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED <br /> (LI14Ck as fI apply) ❑ 1 SPILLCONTAINMENT ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> 4,LL ❑ 2. DROP TUBE ? ❑ 2. BALL FLOAT ❑ 4. EXEMPT AW' <br /> ❑ 3. STRIKER PLATE <br /> N. TANK LEAK DETECTION <br /> IFSINGLEWALLTANK CAeckadf IF DOUBLE WALL TANK ORTANK%TfH BLADDER C 0I0 ): <br /> ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ Z AUTOMATIC TANK GAUGING(ATG) ❑ B. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING <br /> f� ' <br /> ❑ 3. CONTINUOUS ATG I ❑ T. GROUNDWATER / ❑ 3. MANUAL MONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ S. TANK TESTING L <br /> SIENNIAL TANK TESTING 0. OTHER <br /> V.TillllIll I I I 1 RE INFO TION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATEDD LAST Y) EBT EDOUPN OF SUBSTAN REMAINING 435 TANK FILLEOWITH INERT MATE Lp <br /> �S �� 9ellona ❑Va4 No <br /> (�) 51ylo 1 <br /> CUPAFORM(4199) ,wo, Formerly SWRCB Form B <br />