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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Mro Pages w tank) <br /> Page _ of <br /> TYPE Of ACTION ❑1.NEW BRE PERMIT ❑ 4.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE <br /> (CDeek aro hem eldy) PERMANENTLY CLOSED ONSITE <br /> ❑3.RENEWAL PERMIT (BpeaFY�eop-p/lp yuM ppy.) ($pep/ychonps-b/ION u»oNy) 8-TANK REMOVED a]D O <br /> BUSINESS�ISanM as FA/Gll a�-Dd^g. B�+B°+°A� �sNG FACILITY IDt <br /> AA <br /> L TONWI�INSITE(O ""E ° <br /> I.TANK DESCRIPTION <br /> TANK ID TANKMANUFAL RER COMPARTMENTALIZED AN ❑ Yaa No <br /> ,I / It-YYi,com0lata oM".la eaN co Pa m. <br /> r I <br /> DATE INSTALLED(YEAR44O) TANK CA AC IN GA lANB NUMBER OF COMPARTMENTS <br /> i 9 k !J taoo <br /> ADDITIONAL DESCRIPTION(F al uas oMy) <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED FE3 <br /> . IEADEO ❑ 5. JET FUEL <br /> (Hmarkad,compIBN PNmY°m Trya) ❑1D. PREMIUM UNLEADED . DIESEL ❑ B. AVIATION FUEL - <br /> ❑ 2. NONFUELPETROLEUM ❑1c MIDGRAOE UNLEADED . GASOHOL X99. OTHER <br /> ��a SSP , of <br /> ❑ CHEMICAL PRODUCT COMMON NAME(Imre Haaaelpae MafenMs le-Wq page) CAS Y(bpm HaaeMpaa McMaaH 1-ro gpeps) <br /> 4 HA2ARDCJS WASTE(IMr s <br /> U»tl Oi9 <br /> i UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1 SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER ❑95 UNKNOWN <br /> (Lhockoho item DOUBLEWALL <br /> ❑ 4. SINGLE WALL IN A VAULT [IN OTHER <br /> TANK MATERIAL-pdmaq ❑ 1 BARE STEEL �❑ 3 FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> (Crock ala dem o*) ❑ 2. STAINLESS STEEL ii"�l STEELCUDWNIBERGLASS ❑ & FRP COMPATIBLE W110D%METHANOL ❑99. OTHER <br /> V REINFORCED PLASTIC FRP) <br /> TANK MATERIAL-eacaoftq Wk ❑ I BARE STEEL 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE W1103%METHANOL ❑95. UNKNOWN <br /> (CDeck orla dem aMy) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑Be. OTHER <br /> REINFORCED PLASTIC(FRP) ❑1D. COATED STEEL <br /> ❑ S.CONCRETE <br /> TANK INTERIOR LINING DATE INSTALLED <br /> OR COATING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. CUSS LINING ❑95. UNKNOWTU3] <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING . UNLINED 099. OTHER Fa Ponluee <br /> orrodemon ) DATE INSTALLED <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Fa kcal use oMy) <br /> (CSeckonedem m 2. SACRIFICIALANODE <br /> SPILL AND OVERFILL YEARINSTALLED TYPE(FaaK:el..*) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Chock ap'he,apply) ❑ 1. SPILL CONTAINMENT ❑ 1.ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALLFLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> V.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK Lhocx eYIMI a IF DOUBLE WALL TANK OR TANK WITH BLADDER Chock one item paly) <br /> : <br /> ❑ 1. VISUAL(EXPOSEDPORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2, AUTOMATIC TANK CAWING(ATG) ❑ 8. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 8. TANKTESTING <br /> BIENNIAL TANK TESTING 0. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED TU�OI Y) ESTIMATED QUANTITY OF SUBSTA LE REMAINING 435 TA NK FILLED WITH INERT MATERIAL? <br /> ❑Yee Na <br /> CUPAFORM(4/99) �./ FoTneoy SWRCB Form 5 <br />