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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages cer Mnp Page _ of _ TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE (Chock one Mm oMy) ,�.wa1 ❑3.RENEWAL PERMIT -9 T. PERMANENTLY CLOSED ON SITE (Spopy naaon-rorhs;alua orpg (SpNVYy tlwrye-brhtcMu .w ❑ B. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME w DBA-Don,,Businass AS) FACILITY ID/ 'raw L.a I � QoD o� %u ' 1 � (J LOCATION WITHIN SITE(0p6'om1/ 4 1 I.TANK DESGRRRION TANK ID/ TANK MANUFACTURER 0 V O'.^ \ COMPARTMENTALIZEDTANN ❑ Yea 1/.A/1 If'Vaa'.camPMla wx PaP M eWl wmPWrent. DATE INSTALLED(YEARMO) TANK CA A RY IN GALLONS UMBER OF COMPARTMENTS Rp l IZe► Re E Pr�1zGQ Ceo03L5 r In 116 ADDITI L DESCRIPTION(For as poly, IL.TANK CONTENTS .�yy�1 TANK USE 432 ,.4 PETROLEUM TYPE lht MOTOR VEHICLE FUEL LJ 1a. REGULARUNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (IRrarkM,wmAIs*PMmhum Typy 61p PREMIUMUNLEADEDr �1�1____ e4 113. DIESEL 13S. AVIATION FUEL 112. NON-FUEL PETROLEUM 13 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3. CHEMICALPRODUCT ❑ 4. HAZARDOUS WASTE lovokoles COMMON NAME(npm NezeNoua MaM1MA/nvenfory Pe9e1 CAB/Prom HazaN Ma(eMls 1pysM"pe9el 110 Usetl OMJ IN.TANK CONSTRUCTION TYPE OF TANK aL t SINGLE WALL ❑ 3. SINGLE WALL W TH ❑ 5. SINGLE WALL NTH INTERNAL BLADDER SYSTEM (CMckom Mem ony) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 09p UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑89. OTHER TANK MATERIAL-pMmTW_W'_ 1. BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE 13 95. UNKNOWN (CMckanssemwlly) ❑ 2. STAINLESSSTEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ 8. FRP COMPATIBLE W/100%METHANOL 1199. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secxnKa,Wa k 13 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE W/10(1%METHANOL ❑95. UNKNOWN lCteckom item poly,11"el fy ❑ 2. STAINLESSSTEEL ❑ 4. STEELCLADWIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET 13 0. OTHER /L REINFORCED PLASTIC(FRP) 010, COATED STEEL ❑ 5. CONCRETE .�-.ss(/ TANK INTERIOR LINING 11 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING gf.P UNKNOWN433 DATE INSTALLED OR COATING (CMcx om Mrrl o El2. ALKYD LINING 134. PHENOLIC UNING 138. UNLINED 13 99. OTHER OTHER (FwbcN um PROTECTION IF ON 13 t MANUFACTUREDCATHODIC ❑ S. FIBERGLASS REINFORCED PLASTIC K95. UNKNOWN 434 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT 1199. OTHER (CMWom Mmonly) ❑ 2, SACRIFICIAL ANODE I lForbcel use oNy, SPILLAND OVERFILL OIj K►aotAoJ YEAR INSTALLED TYPE(Forkmal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (CMC*"past appy) ❑ 1. SPILLCONTUNMENT ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE .F. D '.,. . IV. TANK LEAKOETECTKIN IF SINGLE WALL TANK(Check all lhal apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 8. VADOSEZONE ❑ 2. CONTINUOUSINTERSTITIALMONITORING ❑ 3. CONTINUOUS ATG ❑ T. GROUNDWATER ❑ 3. NANUALMONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑ 8. TANK TESTING BIENNIAL TANK TESTING 13 0. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRNOp3AY) ESTIMATED QUANTITY OF SUBSTANCCE/�LEMAINING 435 TANK FILLED`MTH INERT MATERIAL? •• yksa.�� 14 5� V tiVara V psaon. ❑Yae ❑Np V V v'L� v4 -rh42.i5e. --r"L<s L.0 9fZit J0eS R�650LT or A- T, WA-0.5 �,{/I d 'sv� CUPx/,.] 440 / AFORM(4/99) -f^, � �� � (a7, �` ''v`"`^I • Formery SWRCB Form 8