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.. Current UST Site Survey Forrrl <br /> California State Water Resources Control Board <br /> Avenge Information Inspector. -f-�i-iQ (3Pt995 Agency. (I"` �L— <br /> Reason fiat ORcpav O Release investigation OCompliance inspection <br /> OOthcr <br /> Site Information <br /> Sitenarn : <br /> Adder: Y15 y � (+ <br /> Cityc>CtiLtL.uunry eL Qi�.LIiVIJ <br /> Street Address _ ^- / / - <br /> Fact,tv tvoe: )Retail Gasoline Outlet other A.l_ ••M '1j GC S�"Q)7:19.1 <br /> �'ct�m fn(orPy�jpp U-�� <br /> Imk Material: <br /> are Steel ❑Mfr.C.P. ❑Retrofit C.P. ❑Lined+C.P. (]Clad ❑Fiberglass pother <br /> _. Walls: , 0iingm wall ❑Double wall <br /> Produce 19GMoline ❑Diesel <br /> Age: O<5yr 05-10yr 011-15yr v9>15yr <br /> Upgrade: OSpill Ooverfill O Striker Plate .. <br /> Pin n¢ <br /> Material: Ib{IBarc steel OC.P. ❑Rigid fiberglass ❑Flexible - <br /> Walls: �S' ingle ❑Double <br /> Age: 0<5yr 05-10yr 011-15yr X>15yr <br /> m . <br /> Contamene ODispensc rte OTtubiMone /" <br /> Pumping: OPressure OConventional Suction Rafe suction OCmvrry <br /> T eak Detection L <br /> Methodist ed at timimeidentifrd u <br /> tcl Ae'f orelewc: Np. fol^.I N� <br /> OMIP, O SuttW dispenser containment LD OSIR(Brand/Model <br /> OTT(Brand/Model 1 OPT(BrnnllModel l <br /> OINT(Brand/Model 1 OATG (Brand/Model ) <br /> OGW(Brand/Model 1 OVadose(Brand(Model 1 <br /> - OMecILLLD(Bnnd/Model 1 ❑Elect LLD(Bnnd/Model l - - <br /> Lag= Opus OFail ❑Inconclusive Date: <br /> Lag= OPau OFail Olnconclusive - Dater <br /> LA95IR7 OPIUM _ OFail Olnconclusive Date: - <br /> Release Information ,/ �y <br /> ONo¢lease m <br /> suspected(skip mainder of section) Date of confirmed release <br /> Ca.sc- ❑Physical damage OCoimsion ❑Mechanical failum ❑ Loose Fitting..; ❑ Overfill <br /> OFaulry installation ❑ Structural Failum ❑ Spill Unknown ❑Other <br /> Source .* OTank (:]Piping ODispemer OSpill ❑OvLLL,,,��efll py Unknown ❑Other ) <br /> How identified? OLDrrethod(s) specify plClosu /Removal pother s=• < <br /> Frirr>'ted agp, I�sr,ORecrnt(< lyr) �IOId(>Iyr) QUnknnown <br /> Bti�•xttent OLocalized tank ❑Localize/d`piping OLo lized Dispenser OLargc(beyond excavated area) OOIT-site <br /> Pmducl released Gasoline Diesel <br /> (3/98) Inforrttation provided for this study does not supersede standard reporting requirements. - - <br />