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UNIFIED PROGR M CONSOLIDATED FORM Q <br /> TA.7iS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 1?� <br /> (two Pagespe tank <br /> TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ i AMENDED PERMIT 0 SCHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE P.de_ar <br /> ieee iim ooly) X 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (sp<arr^,�.-Nr acalu,:mh) fspPdry�..rPP-frit,..m1y) a TANK REMOVED un <br /> BUSINESS NAh (swan Pncum HAME noes-pPma eP®«n.) FACILITY ID: 1 <br /> IR, <br /> LOCATION WITHIN SrrE(op, ..0 <br /> � q 31 <br /> L TANK DESCREMON (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to th local agency.) <br /> T N n 432 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK Yes No 91 < <br /> (,f n If Yn".m�Nae me P.6e 6r e.4 mo>p.rtn�ml. <br /> DA QJSTALLED YEAR/MO) OS TANK CAPACITY GALLONS .36 NUMBER OF COMPARTMENTS .31 <br /> ADDITIONAL DESCRIPTION(FP,lonl n..mh) 838 <br /> U.TANK CONTENTS <br /> TA14A U SE 439 PC,RCLCUM.TY:E <br /> I. MOTOR VEHICLE FUEL la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL <br /> (prmnad m.pia<PaPlwm TyP<) 0I1p. PREMIUM UNLEADED 03. DIESEL C3 6. AVIATION FUEL <br /> ❑- NON-FUEL PETROLEUM ❑ Ic. MIDGRADE UNLEADED ❑i. GASOHOL ❑99.OTT ER <br /> ❑3. CHEMICAL PRODUCT COMMON NAME Liam NmNm, Marm.h b.mpry p.a.l 111 CAS#(fin.11..,dm,Mneri.I. <br /> ❑9. HAZARDOUS WASTE. <br /> Ia<k.d<,urPd ox) <br /> 95 UNKNOWN J <br /> III. TANK CONSTRUCTION <br /> rYPE OF TANK 01, SINGLE WALL 3 SINGLE WALL WITH ❑5 SINGLE WALL WITH INTERNAL BLADDER SYSTEM ++1 <br /> Khak nu<nnP mlyl EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> 2. DOUBLE WALL ❑J. SIGNIL WALL IN VAULT ❑99, OTHER <br /> TANK MATERIAL-r^marr ud I. BARE STEEL 03 FIBERGLASS/PLASTIC 0 5. CONCRETE 09. UNKNOWN "a <br /> (Chttk m<n<m mlp ❑L STAINLESS STEEL [14. STEEL CLAD W/FIDERGLASS ❑3. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-mmdapq link I. BARE STEEL _ FIBERGLASS/PLASTIC 0 5. CONCRETE El 95 UNKNOWN •+5 <br /> (a-a m<..m m1y) ❑2. STAINLESS STEEL ❑i STEEL CLAD W/FIBERGLASS CIS. FRP COMPfIBLE W/100%METBANOL ❑99 OTHER <br /> REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL <br /> ❑5. CONCRETE <br /> 1"AHK INTERIOR LINING ❑ I.RUBBER LINED D 3.EPDXY LINING ��5,GLASS LINING 95.UNKNOWN lie DATE INSTALLED "7 <br /> Oil COATING C1'_ALKYD LINING ❑d PHENOLIC LINING `b[6 tI7JLINED ❑99 OTHER <br /> fCT<ck me.em only) � �. (Fm bulum Pnly) <br /> OTHER CORROSION ❑ I MA!dI1FACTURED CATN.ODIC ❑}FlllERGLA55 RE(NFORrED PLASTIC ❑95 UNK^IOWN "s DATE INSTALLED "9 <br /> PROTECTION IF APPLICABLE PROTECTION ❑i IMPRESSED CURRENT ❑99 OTHER <br /> (0—km.3.mm1y) 0 SACRIFICIAL ANODE (Fnrmuluaa..10 <br /> SPILL AND OVERFILL YEARINSTALLED 459 TYPEIIocalur<PPIy) 01 OVERFILL PROTECTION EQUIPMENT:YEAR INSDALLED +Sz <br /> R>,ea1.111n.uprhl �.r I SPILL CONTAINMENT ❑ <br /> q 1 ALARMFILL TIIOE SIIl1T OFF VALVE <br /> 2 DROP TUBE ❑2 BALL FLOAT ❑ 1 XEMPT <br /> 3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(n a<.<nPiao Prm<PbPuo.,ue Pmsmm al,•111K w6-1-1 w m.kcal.rm<y.) <br /> IF SINGLE WALL TANK(Chr<k.umaupplr) 113 IF DOUBLE WALL TANK OR TANK WITH BLADDER <br /> Elk one.aP Pn1' <br /> ❑ I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) [II VISUAL(SINGLE WALL IN VAULT ONLY) <br /> C3 AUTOMATIC TANK GAUGING(ATG) 0 VADOSE ZONE V'-CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER [:1 3 MANUAL MONITORING <br /> ❑.STATISTICAL INVENTORY RECONCILIATION ❑STANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORINLITION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) ... ESTIMATED QUANTITY OF SUBSTANCE REMAINING "o TANK FILLED WITH INERT MATERIAL' 157 <br /> gallons [] Yes ❑ No <br /> UPCF(12/99 revised) 10 11.4 Formerly SWRCB Form B <br />