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f `FEED PROGRAM CONSOLIDATED FO' lqkww ..W TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page_of_ TYPE OF ACTION Cl I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chak one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specifyr on-fprlouluseonly) (Speafymseon-forlocaluseonly) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Soon a FACILITY NAME or DBA-Doing Business As) FACILITY ID: AVO ' LOCATION WITHIN SITE(opsin w) 431 3618 , f4 mwirer q k� S%aC gC TO� 1.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# a32 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Lj Yes No 434 13 1 OLV@n15 (OeNI1J If-Yu,onmpleteonep tbreaahcornpamenc DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 036 NUMBER OF COMPARTMENTS 437 i�k,(L 1 ADDITIONAL DESCRIPTION(For low a,e only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 15(1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (Ifmathed maplcic Pen I.Type) M[It. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM [Ile. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (Gash H Joa Maseriab Invetory Palle) 441 CAS#(Goon HazarA a Metcnals Immtosy page) 442 ❑4. HAZARDOUS WASTE (Include Used Oil) [195.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [13. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM u3 (ChmIc one nem only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-punas,tack 0 I. BARE STEEL X3. FIBERGLASS/PLASTIC 0 5. CONCRETE 95. UNKNOWN 444 (Check one iron only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-amondarytaik 0 1. BARE STEEL %3. FIBERGLASS/PLASTIC LJ 5. CONCRETE C3 95. UNKNOWN 445 (Check co,item only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [IS. FRP COMPTBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LLNING ❑1.RUBBER LINED 3.EPDXY LINING 5.GLASS LINING 0 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Chmk one ilea only) (Fm local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC 1%3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN dda as PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER (Chmk one item only) ❑2 SACRIFICIAL ANODE I Forlowaaeoaly) SPILL AND OVERFILL YEAR INSTALLED pp 450 TYPE(low ore only) 451 OVERFILL PROTECTION 1,7EQUIPM/ENT:YEAR INSTALLED 452 Whack all all ch.apply) 191 SPILL CONTAINMENT IW ALARM FILL TUBE SHUT OFF VALVE 59 2 DROP TUBE ❑2 BALL FLOAT ❑4 EXEMPT ly 3 STRIKER PLATE IV.TANK LEAK DETECTION(A descnpdon of the monitoring program shall W sahatued no the local all IF SINGLE WALL TANK(Check all the apply) 153 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANTO GAUGING(ATG) ❑6 VADOSE ZONE A4-CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR'MO/DAY) J55 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL'? 357 nations ❑Yes ❑ No UPCF(1/99 revised) 173 �./ Formerly SWRCB Form B