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v <br /> ED PROGRAM CONSOLIDATED FOf f 0, <br /> I' y�D t) TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 I I 1 4, <br /> (two pages per tank) <br /> Page of <br /> TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED -M 430 <br /> BUSINESS NAME(Same as FACII.ITY NAME or DBA-Doing Business As) 3 FACILITY ID: 1 <br /> ARCO FACILITY#2076 <br /> LOCATION WITHIN SITE(optional) 431 <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.) <br /> TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 <br /> UNI.#1 / D XERXES If"Yes",complete one page for each compartment. <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> 1/1992 10,000 1 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> IL TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ®1. MOTOR VEHICLE FUEL ®la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL <br /> (Rmarked complete Petroleum Type) ❑lb- PREMIUM UNLEADED [13. DIESEL ❑6. AVIATION FUEL <br /> [12. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER_ <br /> ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 <br /> ❑4. HAZARDOUS WASTE GASOLINE 8006-61-9 <br /> (Includes Used oil) <br /> ❑95.UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK ❑1. SINGLE WALL [13. SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Check one item only) EXTERIOR MEMBRANE LINER [195. UNKNOWN <br /> ®2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT [199. OTHER <br /> TANK MATERIAL-primary tank ❑1. BARE STEEL-0 3. FIBERGLASS/PLASTIC [15. CONCRETE ❑95. UNKNOWN 444 <br /> (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS 118. FRP COMPTIBLE W/100%METHANOL ❑99-OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-secondary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC [15. CONCRETE ❑95. UNKNOWN 445 <br /> (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS 118. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) [110.COATED STEEL <br /> [15. CONCRETE <br /> TANK INTERIOR LINING ❑1.RUBBER LINED [13.EPDXY LINING [15.GLASS LININ G• [195.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER <br /> (Check one item only) (For local use oily) <br /> 448 448 <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC El3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN <br /> PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER <br /> (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENI:YEAR INSTALLED 452 <br /> (Check all that apply) ®1 SPILL CONTAINMENT 2003 Phil-tlte ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE <br /> ®2 DROP TUBE 2003 Phil-tite ®2 BALL FLOAT ❑4 EXEMPT <br /> ❑3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) <br /> IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> (Check one item only) <br /> ❑I VISUAL(E3sPOSED PORTION ONLY) [:15 MANUAL TANK GAUGING(MTG) ❑I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 451 <br /> 0 gallons ❑Yes ❑ No <br />