Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> (two pages per tank) <br /> P., o_Z+ of 3_ <br /> TYPEOFACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT . CHANGEOFINFORMATION) ❑ 6. TEMPORARY SITE CLOSURE <br /> (Chock -41 ❑ T. PERMANENTLY CLOSED ON SITE v <br /> ❑3.RENEWAL PERMIT (Sp.,yre.aon hVio.al. nW (SpeRTy olroage-/prlocM u»only) ❑ B. TANK REMOVED 430 <br /> BUSINESS NAME(Same a FACILITY NAME or DBA-Dotr®Ruairroea A.) FACILITY 100 8 1 1,0D <br /> S` n0- � I25Rq Y ` <br /> LOCATITHINSIT . u S 1.TANK DESCRIPTION <br /> TANK ID TANKIMNUFACTURER COMPARTMENTALIZED TANK 13 Yea No <br /> II-YW complete one p.ge for eam com anmeM. <br /> DATE INSTALLED(YEARIMO) TANK CAPACITY IN GALLONS ry NUMBER OF COMPARTMENTS <br /> ADDITIONAL DESCRIPTION(ForkrW ua only) <br /> II.TANK CONTENTS <br /> ,�,� TANK USE 432 PETROLEUM TYPE <br /> J� 1. MOTORVEHICLE FUEL , 1a REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (R IM4.cnmpble PMmlaom Type) 0 t.. PREMIUM UNLEADED ❑ 3. dESEI ❑6. AVIATION FUEL <br /> ❑ 2. NOWFUEL PETROLEUM tc MIDGRAOE UNLEADED ❑ 4. GASOHOL ❑W. OTHER <br /> ❑ 3.CHEMICAL PRODUCT <br /> ❑ 1. HAUROOUS WASTE(IM.Ws COMMON NAME(Isom Hazareous MaWials Inwnfory paps) CAS F(Mm Ha>:allous MabaialS Inwnforypeye) <br /> UseE 01, <br /> IN.TANK CONSTRUCTION <br /> TYPE OF TANK . SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Chock one am only) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> ❑ 4. SINGLE WALL IN A VAULT 0 99 OTHER <br /> TANK MATERIAL-"any t>M 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 09. UNKNOWN <br /> (CM1eck ane ibm ahoy) ❑ 2_ STAINLESS STEEL ❑4. STEEL CLAD WIFISERGLASS ❑ 8. FRP COMPATIBLE W/1 00%METHANOL ON. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-acrld"Wk •.1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ B. FRP COMPATIBLE Wil W%METHANOL 0e5. UNKNOWN <br /> (Chock.ibm only) ❑ 2 STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET W. OTHER <br /> REINFORCED PLASTIC(FRP) 1110 COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN403 DATEINSTALLED <br /> OR COATING �/ <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING )Q B. UNLINED ❑99. OTHER <br /> CMGoro ibm ) l� � ForbW useo <br /> OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC . UNKNOWN 434 DATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT ❑99. OTHER <br /> (Chocks "olcme) ❑ 2. SACRIFICIALANODE (Falocalaeony) <br /> L <br /> SPILL AND OVERFILL 1 INST ED TYPE(Forbcaloa .W OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED <br /> (Ckaok d that apply) 0 1, SPILLCONTAINMENT ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> 4- <br /> Af. TANK LEAK DETEG7ION . <br /> IF SINGLE WALL TANK Chock 0 Mad a IF DOUBLE WALL TANK OR TANK WITH BUDDER Chock caro Men only): <br /> ❑ 1. VISUAL IEXPOSEDFORTION ONLY) ❑ 5. MANUAL TANK GAUGING INTO) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE ❑ 2. CONTINUOUSINTERSTITIALMONITORING <br /> ❑ 3. CONTINUOUSATG ❑ T GROUNDWATER ❑ 3. MANUAL MONITORING <br /> ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR) �JB❑/B. TANK TESTING <br /> 1 �,I <br /> BIENNIALTANKTESTING X. OTHER fy&YU, <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRR40/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED WITH INERT MATERIAL? <br /> l!K J D ams ❑Yes No <br /> CUPAFORM(4/99) Formerly SWRCB Form 8 <br /> Nk./r `e.ae <br />