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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 7 q X11 ,J (Iwo pages per lank) ,_,// n/AA/� /] ;G( Page _ of _ TYPE OF ACTION 101.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATIONI ❑ e. TEMPORARY SITE CLOSURE (Check one ibm only) ❑ T. PERMANENTLY CLOSED ON SITE 713.RENEWAL PERMIT (Specly,mason-forlocaluM onyJ (Specify change-/oz lcwl use only) ❑ B. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME w DBA-Doing Business As) FACILITY 10 N t 10013,40111110 111111 LOCATION IMTHIN SITE(OptiorinQ 431 2D1D Sr EI Dora 'iho51.551-7 I.TANK DESCRIPTION TANK ID% TANK MANUFACTURER COMPARTMENTALIZED TANK 71 Yes 0 No I ( 1 IA k, it Y.e.rnmPIWQ one papa for each wmpartranl. DATE INSTALLED(YEAI(RR11,10))L1�T� �� TANK CAPACITY IN GA1/LLLLOON/NSS,�J NUMBER OF COMPARTMENTS M '�YVeV - ADDITIONAL DESCRIPTION(Forlocal uaa oMy) 11.TANK CONTENTS TANK USE 432 PETROLEUM TYPE D 1,MOTOR VEHICLE FUEL 71 U. REGULAR UNLEADED 71 2. LEADED ❑ 5. JET FUEL ' (If mafkeg,wrn mia PehWeum Type) D ib. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 8. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM D 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑89. OTHER ❑ 3.CHEMICAL PRODUCT D 4. -RDOUS WASTE(IncluCea COMMON NAME(ft.Hu nicus Materials Inwnfory Page) CAS 0 pram Hazallous Materials Inwntwy page) Uaee Op WN Ill.TANK CONSTRUCTION TYPE OF TANK i, SINGLE WALL 0 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check Dna ibm Dory) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 71 4, SINGLE WALL IN A VAULT 99 OTHER TANK MATERIAL-granary tank i. BARE STEEL D 3. FIBERGLASS/PLASTIC D 5. CONCRETE 1:195. UNKNOWN (Check arra dam only) 0 2. STAINLESS STEEL 11 4. STEEL CLAD W/FIBERGLASS 11 8. FRP COMPATIBLE WH00%METHANOL 1189. OTHER REINFORCED PLASTIC FRPJ TANK MATERIAL-sewn4ary tank 0 1 BARE STEEL 71 3. FIBERGLASS/PLASTIC 11 8, FRP COMPATIBLE W/100%METHANOL 1195. UNKNOWN (Check one item only) 0 2. STAINLESS STEEL 0 4. STEEL CUD WIFISERGUSS 09, FRP NON-CORRODIBLE JACKET 099. OTHER REINFORCED PUSTIC(FRP) 1110. COATED STEEL 11 S.CONCRETE TANK INTERIOR LINING D 1, RUBBER LINED 71 3. EPDXY LINING 11 5. GLASS UNING 0 95. UNKNOM433 DATE INSTALLED OR COATING ❑ 2. ALKYD LINING 0 4. PHENOLIC LINING 0 e. UNLINED 7199. OTHER (Check ox item c ) Forlwal use onl) OTHERPROTECTION CORROSION IF ON ❑ 1 MANUFACTURED CATHODIC 11 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 DATE IN$TALLED PROTECTION IF APPLICABLE PROTECTION D IMPRESSED CURRENT ❑89.OTHER (Check orle item Only) ❑ 2.SACRIFICIAL ANODE (Forbcal use only) , $PILL AND OVERFILL YEAR INSTALLED TYPE(Forlccal useonM OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check ad that apply) ❑ 1 SPILLCOWAINMENT ❑ _1. AURM ❑ 3. FILL TUBE SHUT OFF VALVE D 2. DROPTUBE ❑ 2. BALL FLOAT ❑ C EXEMPT 0 3. STRIKER PLATE IV. TANK LEAK DETECTION IF SINGLE WALL TANK Check ell thala Ily, IF DOUBLE WALL TANK OR TANK WITH BUDDER(Check one item only): ❑ 1. VISUAL(EXPOSED PORTION ONLY) 71 5. MANUAL TANK GAUGING(MTG) 11 1. VISUAL(SINGLE WALLIN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) 11 B. VAOOSEZONE 11 2. CONTINUOUS INTERSTITIALMOMTORING ❑ 3. CONTINUOUSATG 0 T. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)a 11 8. TANKTESTING BIENNIAL TANK TESTING 099. OTHER V.TANK CLOSURE INFORMATION I PERMANENTCLOSURE IN PLACE ESTIMATED DATE OADAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED WITH INERT MATERIAL'! fig pit.. ❑Yes ❑No av CUPAFORM(4/99) • Formerly SWRCB Form B tics a8/oi/off