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Ila 71� <br /> ( <br /> UNIFIED PROGRAM CONSOLIDATED FORM S <br /> UNDERGROUND STORAGE TANKS-TANK PAGE I (` � � 1 <br /> (Avo Pages per tank) <br /> Papa _ Of - <br /> ❑ 5.CHANGE OF INFORMATION) ❑ 8. TEMPORARY SITE CLOSURE <br /> ttPE OF ACTON ❑1.NEW SITE PERMIT ❑ <. AMENDED PERMIT 0 T. PERMANENTLY CLOSED ON SITE <br /> (crock am Rem on99 <br /> Lyf.RENEWAL PERMIT (SPecIlY neon-TOTbcel uae otRN (SpeaNdls,Ipe-���� ❑ 8. TANK REMOVED 13o t <br /> BUSINESS NAME,,(Same ee FFaA_CIUTY� NA/M�E or DBA`y-Dpitp 9winw Ae) <br /> FAGUTY 10 <br /> LOCATIONWITHINSITE(OpBenM /3f <br /> }119 04 <br /> I.TANK OESCPoPTION ❑ No <br /> TANKMANUFACTURER COMPARTMENTALIZEDTANK Q�"fBR <br /> TANK 100 �l //�1 I'' ` 1,'Mr,oomplete ane Pepe M MKI,camPe,imi <br /> 7,-4 '� () 7 Jf/>� A�a� �` ` �N� � NUMBER OF COMPARTMENTS <br /> DATE INSTALLED(YEyA'R/_IMO) TANK CAPACITY IN GALLON <br /> ADDITIONAL DESCRIPTION(FOTb uae mRY1 <br /> 11,TANKCONTENTS <br /> ,� TANK USE 132 PETROLEUM TYPE Cl S.JET FUEL <br /> Lq 1. MOTOR VEHICLE FUEL ❑ta. REGULAR UNLEADED ❑ 2. LEADED r�L - <br /> (R meME.no plete Pefmlwm Typal ❑te. PREMIUM.UNLEADED ❑ 3. DIESEL tea.AYIATIDN FUEL <br /> ❑ 2.NONFUEL PETROLEUM ❑ 4.GASOHOL ❑B9.OTHER <br /> ❑to MIDGRADE UNLEADED <br /> ❑ 3.CHEMICAL PRODUCTdee, <br /> GSY(hom Hunnicope MetedaMlnveolory Pelle) <br /> COMMON NAME(Imtn H@Mmboa MBMdee Iment"I'I'N ) <br /> ❑4, H RDOUS WASTE(InclMoea <br /> Ueed OR) <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ t SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5.,SINGLE WALLHATH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER 085. UNKNOWN <br /> (CmnFom Rem omH ["�2. DOUBLE WALL q SINGLE WALL IN A VAULT 089. OTHER <br /> TANK MATERIAL-prmepf lank ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> ❑ 1. 040.E STEEL <br /> (CMCM pM ksm oNy) ❑ 2.STAINLESS STEEL Cl'C STEEL CLADWIFISERGLASS ❑ 8. FRPCCMPATIBLEW/IW%METHANOL ❑99. OTHER <br /> REINFORCEDPLASTIC FRP) <br /> TANK MATERIAL-eewMerY lank t BARE STEEL ❑ 3. FISERGLASSIPUSTKC ❑ 8. FRP COMPATIBLE Wil"METHANOL ❑95. UNKNOWN <br /> ,.., <br /> (CmckaleR eow,Y) 112. STAINLESS STEEL l7 1. STEELCtADWIFlBERGLASS ❑ 9. FRP NON.CORRODIBLE JACKET <br /> REINFORCED PLASTIC(FRP) 010 COATED STEEL <br /> ❑ 5. CONCRETE <br /> ,..a/ PATE INSTALLED <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING 115. GIASSLINING L143. UNKNOOWN33 <br /> OR COATING [1 4, PHENOLIC LINING ❑ e. UNLINED El 99 OTHER wKK,M pa on 1 <br /> ❑ 2.ALKYD LINING DATE INSTALLED <br /> (Check arra Rem <br /> OTHER CORROSION ❑ 1.MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 131 <br /> PROTECTION IF APPLICABLE PROTECTION0 99. CTHER (Fabul pde oMy) <br /> ❑ 1. IMPRESSED CURRENT <br /> Knack WM Rem onw ❑ 2. SACRIFICULANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILLANDOVERFILL - )EAR INSTALLED TYPE(ForlocaleoaMy) <br /> (Cmckafmfeppl/) [31< SPILLCONTAINMENT .❑ 1.ALARM q/ ❑ 3. FILL TUBE SHUT OFF VALVE <br /> L-2./DROP TUBE CJ 2. BALL FLOAT y._ O 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER Check one item only): <br /> IF SINGLE WALL TANK(Check all that apply): <br /> ❑ 5. MANUAL TANK GAUGING(MTG) ❑ t VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ t, VISUAL(EXPOSED PORTION ONLY) 12' <br /> ❑Z. AUTOMATIC TANK GAUGING(ATG) ❑ 8. VAOOSE ZONE 9.l!!P. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUS ATG - ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ 8. TANK TESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRAIOIDAY) E5TIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLEOWATH INERT MATERIAL? <br /> '.Ilam ❑Yee ❑No <br /> Formerly SWRCB Form B <br /> CUPAFORM(4/99) <br />