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✓0°l U 1FIED PROGRAM CONSOLIDATED FO T J TANKS UNDERGROUND STORAGE TANKS- TANK PAGE 1 (Two pages per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AIvtENDED PERIvBT ❑ i CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one it..only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reanan) (Specify reason) N 8.TANK REMOVED I. BUSINESS NAME(Samees FACILITY NAhfEor DBA-Doing Business As) 5. FACILITY ID: Hondo Company LLC $q6 g LOCATION WITHIN SIE(Optional) 431. T I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarksCOMPARTMENTALIZED TANK E]Yed to the local es ® No 434. TANK ID# 432, TANK MANUFACTURER 431,2 V"Yes;'wmplete ane page for each wmpartment. DATE I STALLED a3s. TANK CAPACITY IN GALLONS a36_ NUMBER OF COMPARTMENTS 437 (YEAR/MO) 500 ADDITIONAL DESCRIPTION(For local use ody) 438' IL TANK CONTENTS TANK USE 439. PETROLEUM TYPE a4°. N 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (lfchecked,complete Pevoleum Type) ❑ Ib. PREMIUM UNLEADED El 3, DIESEL El 6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑1 c. MIDGRADE UNLEADED ❑4. GASOHOL N 99.OTHER: unlmoven ❑ 3. CHEMICAL PRODUCT COMMON NAME (Rom Hazardous Materials Inventory page)a e 441. CAS#(from Fhoun ous Materiels Inventory page) 442 ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN in TANK CONSTRUCTION TYPE OF TANK N I. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN ❑2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary talc N L BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE [195.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W1100%METHANOL ❑95.UNKNOWN 445. (Check one item only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [19. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑ 10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑3.EPDXY LINING [15.GLASS LINING N 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING [12.ALKYD LINING [14.PHENOLIC LINING ❑6.UNLINED ❑99.OTHER Check one item onl OTHER CORROSION ❑ 1.MANUFACTURED CATHODIC ❑3.FIBERGLASS REINFORCED PLASTIC N 95.UNKNOWN 44s. DATE INSTALLED 449. PROTECTION PROTECTION [14.IMPRESSED CURRENT ❑99.OTHER IfApplicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 45o. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) Ell.SPILL CONTAINMENT ❑2.BAALARM L FLOAT N 4.EXEMPT E SHUT OFF VALVE ❑2.DROP TUBE [13.STRIKER PLATE IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK a53. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) N 1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) [12.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ❑2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG [17.GROUNDWATER ❑3.MANUAL MONITORING [14. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455' ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456' TANK FILLED WITH INERT MATERIAL? 457' 1980 0 gallons [I Yes N No UPCF hwfwre-b(1/99)-1/4 www.BRidocs.org Rev.02/16/00