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�F3?5 <br /> YIFIED PROGRAM CONSOLIDATED FOI <br /> �.s � ANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (two pages per tank) <br /> Pg.-.f_ <br /> TYPE OF ACTION SITE PERMIT [34 AMENDED PERMIT [35 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (C6e3 mviam aa159 (� C37 PERMANENTLY CLOSED q <br /> ❑ 3 RENEWAL PERMIT (Spsdlymaem-fwl uwmty) (spedtyrmroo-rarlam mmty) 8 TANK REMOVED 4A D <br /> BUSINESS NAME P mIY anew-Dairy Ea.iaen a) 5 FACILITY ID: <br /> LriT ©F c a../ <br /> LOCATION WITHIN SITE( ) 43t pl <br /> /DDD /V U^ ST Stockto n -?s p� a3ssD Jul <br /> L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) n / <br /> TANK ID# 432 TANK MANUPAC'1T1RER d33 COMPARTMENTALIZED TANK Ye 0 43( 11C,.1,�1` `Ir',J•-(il <br /> aV'Yd'wmplero omwRtmncn Q Il'� <br /> 435 TANK CAPACITY GALLONS 43a NUMBER OF CO 437 <br /> DATE INSTALLED(YF.AR/MO) Q <br /> ADDCTTONA DHSCRIPTION(Por lam aoly) ("( ) � <br /> IL TANK CONTENTS <br /> TANKUSE 439 PETROLEUM TYPE <br /> ❑I.MOTOR VEHICLE FUEL ❑It REGULAR UNLEADED ❑2. LEADED ❑5. TET FUEL <br /> (Emedee mwk+e Pevobme Tyt») <br /> 010. PREMIUM UNLEADED C)3.DIESEL ❑6.AVIATION FUEL <br /> ❑2.NON-FUEL PETROLEUM ❑le. MIDGRADE UNLEADED ❑4. GASOHOL OTHER <br /> 03.CHEMICAL PRODUCT COMMONNAME(mm l4allom Mewide Mxa "r) HI CAS#(AaalG .Metaids fmmomypw) "2 <br /> ❑4. HAZARDOUS WASTE <br /> (trc Duda)Mr / <br /> 095.UNKNOWN OIL <br /> IQ. TANK CONSTRUCTION <br /> TYPE OF TANK -SINGLE WAI I u 3.SINGLE WALL WITH S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 445 <br /> (Chdamivamy) EXTERIOR M@IDRANE LINER ❑95.UNKNOWN <br /> ❑2. DOUBLE WALL ❑4.SIONLE WALL IN VAULT ❑99. OTHER <br /> TANKMATERIAL-pr®ery . BARE STEEL 13 3. FIBERGLASS/PLASTIC L3 5.CONCRETE 95-UNKNOWN 44N <br /> (Caedcmeitm ady) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FBEROLASS ❑S. FRP COMPITBLB W1H0%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-scmdvy mtLj 1.BARESTEEL 3.FIBERGLASS/PLASTIC 5. CONCRETE U 95.UNKNOWN a5 <br /> (eueaaa.;o®ody) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP coMPTBLE W/100%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) ❑10.COATED STEEL <br /> ❑5.CONCRETE <br /> TANK INTERIORLINING CFI.RUBBERLWED 0 3.EPDXY LINING 5.GLASS LINING 0 95.UNKNOWN 416 DATE INSTALLED M7 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LININGNUNLINED ❑99 OTHER <br /> (CM*...*) (Fmtxetmeody) <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC 0- SUNKNOWN NNe DATE INSTALLED N9 <br /> PROTECTION IF APPLICABLE PROTECTION ❑4 DORESSED CURRENT 0 9 OTHER <br /> (CTc imeNy) ❑2 SACRIFICIAL ANODE (Fmbdmeaob) <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE lomlweaaly) 01 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Oral W ibaceppty) ❑1 SPI L CONTAINMENT 131 ALARM ❑3 FILL TUBE SHUT OFF VALVE <br /> ❑2 DROP TUBE LI ❑2 BALL FLOAT J El EXEMPT <br /> ❑3 STRIKER PLATE p`/ <br /> IV.TANK LEAK DETECTION(w dr npimwsiememwnasyapmduu ee.,t aium manmcY aqm ) <br /> IF SINGLE WALL TANK(cean w iLu.ppry) <br /> 453 IF DOUBLE WALL TANK OR TANK WTM BLADDER 554 <br /> Chat omim <br /> iody) <br /> (EXPOSED PORTION ONLY) E35 MANUAL TANK GAUGING(MIG) 11 1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE TONE ❑2 CONTINUOUS INTERSTITIAL.MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCHIA77ON 0 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTI STED TE U (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 4% TANKFILLEDWTfIINERT TERIAL? (n <br /> gallons [3Yee o <br /> UPCF(12/99 revised) 10 Formerly SWRCB Form B <br />