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OL I2/9/a_-4�0D UNIFIED PROGRAM CONSOLIDATED FORM p AWS UNDERGROUND STORAGE TANKS - TANK PAGE i `\o\ (two 'a P� ) I Aa _et TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANGE OFF TION ❑ 6 TEMPORARY SITE CLOSURE tomk we measly) I ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Speriyieam.-W ImA me.1y) (Spacty m.m.-W bnl u.e mlrl 8 TANK REMOVED 430 BUSINESS NAME(Sum..FACILITY NAME;DBA-Doing Bum.A.) 1 I 1 FACILITY ID: 1 LOCATION 44Q(opem.B Y of L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submi to the local agency.) TANK ID R 433 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes No 434 6') *'5 5 0 la V Ym ee�lNe m<p.8c W M mqu�wm5. DATE INST O) 475 TANK CAPACITY IN ALLONS 436 NUMBER OF COMPARTMENTS 437 2 ©D 0 ,2. ADDfi[O CR1P7'IOON(F.imei me.ely) / 438 U.TANK CONTENTS ' TA14K USE 139 PSTROLrUM TY:E - u0 x1l MOTOR VEHICLE FUEL ❑la REGULAR UNLEADED ❑2. LEADED ❑5. JETFUEL nm urn�plae Pm.lwrn Tywl b. PREMIUM UNLEADED 03. DIESEL [16. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (em wmdes.M.I.leweey P-ae) 441 CASN(6eee t6.ab M.wmai.mm.y wae) u0 ❑4. HAZARDOUS WASTE (mmdm urns an ❑95.UNKNOWN ECL TANK CONSTRUCTION TYPE OFTANK 0 I. SINGLE WALL 3. SINGLE WALL WITH .. ❑S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (CYN:we tem only) EXTERIOR MEMBRANE LINER El 95. UNKNOWN )�2 DOUBLE WALL',. ❑4. GNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-pdm BARE STEEL3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN u4 (rJ,:k eee tem esiyl ❑2. STAINLESS STE ❑4. EL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER FORCED PLASTIC(FRP) TANK MATERIAL-mmad.y wt I. BARE STEEL3. FIBERGLASS/PLASTIC 5. CONCRETE 0 95. UNKNOWN u5 (Clack e.e um my) ❑2. STAINLESS STEEL ❑4. TEEL CLAD W/FIBERGLASS [18. FRP COMFI'IBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING C1 1.RUBBER LINED 0 3.EPDXY LINING 5. S LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING LINED ❑99 OTHER (0,ck we kern mly) (For Wal me eely) OTHER CORROSION ❑ I MANUFACTURED CATHODIC 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED uv PROTECTION IF APPLICABLE PROTECTION ❑ MPRESSEDCURRENT ❑99 OTHER (Check.kern wly) ❑2 SACRIFICIAL ANODE (Foek.eei-eely) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(Wal me wly) i51 OVERFILL PROTECTION EQUIPMENT-YEAR INSTALLED 452 (Reck.Ihw wly) I SPILL CONTAINMENTO� ❑ �A � 1 ❑1 ALARM 3 FILL TUBE SHUT OFF VALVE 121 2 DROP TUBE ��%/ � ❑2 BALL FLOAT ❑4 EXEMPT 3 STRIKER PLATE 14-1"41 IV.TANK LEAK DETECTION(A dem lion etU.ornek.,1".m.11 he.beim!le ne bol.aenry.) IF SINGLE WALL TAN K(Cheekdl tk...wy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (6 kwe tem mir) ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑ VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TE ❑99 OTHER _ ---- CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ( /- ESTIMATED DATE LAT USED(YR/MOMA1 5 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL' 457 ,0 ,-2- gallons ❑Yes ❑ No UPCF(12/99 revised) 10 14./ Formerly SWRCB Folin B