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UNIFIED PROGRAM CONSOLIDATED FOR.Nf <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br /> (two pages <br /> TYPE OF ACTION 0 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE QI <br /> Idmk me.®mir) 7 PERMANENTLY CLOSED ON SITE <br /> ❑ J RENEWAL PERMIT 8 TANK REMOVED 1 4 GI�I <br /> BUSINESS N (sem..FncalrY N,\ME er ow-Doug an®ee A<) FACILITY ID: <br /> LOCATION WITHIN SITE(om..B It <br /> L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to thl local agency.) <br /> TANK ID N 432 TANK MANUFACTURER 433COMPARTMENTALIZED TANK Yes 4 <br /> V Ym",mogkt<e.e p.ge for ed m�.w.m.. Q I <br /> DATE HJS ALLED YEAR/MO) 435 TANK CAPACITY GALLONS 456 NUMBER OF COMPARTMENTS » <br /> ADDITIONAL DESCRIPTION(F-i—i—jo +sg <br /> H.TANK CONTENTS <br /> TAi4K USE 114 PF.11OLDUM TYSE <br /> 9I. MOTOR VEHICLE FUELa. REGULAR UNLEADED ❑:. LEADED ❑5. JET FUEL <br /> pt m,ne wnglme Pa.olmm Tyyel I . PREMIUM UNLEADED ❑). DIESEL ❑6. AVIATION FUEL <br /> 02 NON-FUEL PETROLEUM ❑ le. MIDGRADEUNLEADED ❑4. GASOHOL ❑99.OTHER <br /> ❑J. CHEMICAL PRODUCT COMMON NAME 16em w..bm..M .l.bvmr«yv.gel H1 GA$t!(g.m l4x.rdmr M..s i.lsln�roryp.gel ++ <br /> ❑4. HAZARDOUS WASTE. <br /> (Includes U.d pd) <br /> ❑95.UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TYPEOFTANK I. SINGLE WALL 03. SINGLE WALL WITH ❑5. SINGLE WALL WITII INTERNAL BLADDER SYSTEM ++ <br /> ICLaek men.m mly) EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> '_. DOUBLE WALL ❑4. SONLE WALL IN VAULT ❑N OTI LER <br /> TANKMATERIAL-pwury un4 L BARE STEEL 03 FIBERGLASS/PLASTIC 0 5. CONCRETE 0 9. UNKNOWN ++' <br /> ICheet w<nem mlrl ❑'_. STAINLESS STEEL [:14. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPTIBLE W/100%..METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL--.d.,...k 0 I. BARE STEEL 10 FIBERGLASS/PLASTIC 0 5. CONCRETE 095. UNKNOWN 4.5 <br /> (aw menemmyl ❑1. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 0. FRP COMPTIBLE W/100%METHANOL 0 9 OTHER <br /> REINFORCED PLASTIC(rRP) ❑ 10.COATED STEEL <br /> ❑5. CONCRETE <br /> TANK INTERIOR LINING ❑ I.RUBBER LINED 0 J.EPDXY LINING ��5.GLASS LINING 95.UNKNOWN 444 DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING `bL'6 UNLINED ❑99 OTHER <br /> ICkeek me nem mly) \. TF 'bol um nnlvl <br /> OTHER CORROSION O I MANUFACTURED CATHODIC O I FLBER.GLASS REINFORCED PLASTIC ❑95 UNKNOWN u9 DATE INSTALLED '+9 <br /> PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER <br /> (CI«kwe.emn-y) ❑2 SACRIFICIAL ANODE ffnr burvm mivl <br /> SPILL AND OVERFILL YEAR INSTALLED 459 TYPE(I—I'm nuly) 451 OVERFILL PROTECTIONS UIPMENT:YFAR INSTALLED 4'= <br /> ICbmt.nn.n•vplr) I SPILL CONTAINMENT <br /> I ALARM FILL TUBE SHUT OFF VALVE <br /> 1 DROP TUBE ❑2 BALL FLOAT ❑4 XEMPT <br /> 7 STRIKER PLATE <br /> IV.TANK LEAK DETECTION IA d.�ran Anne nonge6ng Rm8mm"ell Im mbmatnd m me ml.gw<y.) <br /> IF SINGLE WALL TANK(Cbeek.am...pply) 451 IF DOUBLE WALL TANK OR TAMC WITH BLADDER +-+ <br /> (Qmk one arm mtyl <br /> ❑ 1 V13UAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑'_AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE '_CONTINUOUS INTERSTITIAL MONITORING <br /> ❑7 CONTINUOUS ATG ❑7 GROUNDWATER ❑7 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING [3 99 OTHER <br /> TV.TANK CLOSURE INFOILNATION/PERDLkNENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRJMOfDAY) 455 ESTIMATED OUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL' +n <br /> gallons ❑ Ycs ❑ No <br /> UPCF(12/99 revised) 10 11�4 Formerly S WRCB Form B <br />