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' UN ED PROGRAM CONSOLIDATED FOR <br />UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br />TYPE OF ACTON 01. NEW SITE PERMIT 04. AMENDED PERMIT <br />(ChecF one kem oNy) <br />❑3. RENEWAL ..r..,..mn.labral use mm <br />TANKS <br />❑ S. CHANGE OF INFORMATION) ❑ 8. TEMPORARY SITE CLOSURE <br />D 7. PERMANENTLY CLOSED ON SITE <br />( PeaN change-IVr luso oNy) ❑ 8. TANK REMOVED 430 <br />PERMIT <br />1 <br />BUSINESSNAME(Bame,a3FACIUTYNAMEar O8A-Ddng/fBussimss%/s As) 7 <br />FACILITYIDe <br />o/✓ ed/ / <br />431 <br />LOCATION WITHIN SITE (Optional) <br />I. TANK DESCRIPTION <br />TANK 10 #6 432 TANK MANUFA TURER <br />433 COMPARTMENTALIZED TANK 0 Yea a 434 <br />Q <br />U I/ 0 ein (L( <br />if -Yea_campleb one Page for ead o "rwert <br />- ` S <br />43 8 NUMBER OFC MPARTMENTS 431 <br />DATE INSTALLED(Y ) 435 TANK CAPACITY IN <br />aa000 <br />�l S � <br />43e <br />ADORIONAL DESCRIPTION (Fwlao/ use only) <br />It. TANK CONTENTS <br />440 <br />TANK USE 439 <br />PETROLEUM TYPE <br />❑ 2. LEADED <br />Cl 5. JET FUEL <br />1. MOTOR VEHICLE FUEL <br />01a. REGULAR UNLEADED <br />0 S. AVIATION FUEL <br />(HmaANd, mmpkbP t m. Type) <br />Qtn. PREMIUM UNLEADED ❑ 3. DIESEL <br />0 2. NON-FUELPETROLEUM <br />MIOGI+ADE UNLEADED ❑ 4. GASOHOLCIO. <br />OTHER <br />❑ 3. CHEMICAL PRODUCT <br />µt <br />CAS HasaN s MaMnala lnwmay Page) 442 <br />S 0( <br />❑ t. HAZARDOUS WASTE (Ilxfudes <br />Used Oil) <br />COMMON NAME (hoxn Haxallous McNuala lnronlwypa9e) <br />COM <br />/ 1IG <br />f // <br />(]7�d44P -6 <br />❑95. UNKNOWN <br />4So C. <br />V <br />IIL TANK CONSTRUC HUN <br />TYPE OF TANK 0 1. SINGLE WALL ❑ 3. SINGLE WALLWHTH <br />❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br />s1�TEXTERIOR MEMBRANE LINER <br />(Chats ane it.. only) 11,2. DOUBLE WALL <br />❑ 95. UNKNOWN <br />4. SINGLE WALL IN A VAULT <br />Cl 99. OTHER <br />TANK MATERIAL -primary tank 0 1 BARE STEEL Cl 3. FIBERGLASS I PLASTIC <br />Cl S. CONCRETE ❑95. UNKNOWN 4M <br />(CI one item any) 0 2. STAINLESS STEEL Y4. STEEL CLAO <br />❑ 8. FRP COMPATIBLE W/100%METHANOL 099. OTHER <br />BERGLASS <br />REINFORCED PLASTIC FR <br />TANK MATERIAL - sxoneary bM 0 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC <br />08. FRPCOMPATIBLEW11M%METHANOL 095. UNKNOWN 4t5 <br />(Deck one item oMy) ❑ 2. STAINLESS STEEL V4. STEEL CLAD WIWBERGLASS <br />09. FRP NON -CORRODIBLE JACKET [:IN. OTHER <br />REINFORCED PLASTIC (FRP) <br />010. COATED STEEL <br />05. CONCRETE <br />TANK INTERIOR UNING 0 1, RUBBER UNED 03. EPDXY LINING <br />0 5. GLASS UNING ❑ 95. UNKNOWN GATE INSTALLED M] <br />448 <br />OR COATING <br />0 2. ALKYD LINING 0 4. PHENOLIC UMNG <br />[I8. UNLINED 99. OTHER FarlKai Y.aa ON <br />Chock one it.. on DATE INSTALLED M9 <br />OTHER CORROSION 0 1. MANUFACTUREDCATHOOIC 03. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 448 <br />PROTECTION IF APPLICABLE PROTECTION ❑ 0. IMPRESSED CURRENT <br />099. OTHER (For lIa;af��,) <br />(Check ane it.. oMy) 0 Z SACRIFICIAL ANODE <br />451 OVERFILL PROTECTION EOUIPMEM: YEAR INSTALLED 452 <br />SPILL AND OVERFILL YEARINNSSTAALLED 450 TYPE(Faf)oal YseoNY) <br />/C� <br />0 3. RILL TUBE SHUT OFF VALVE x <br />Op <br />a� <br />(CHeck aH Mat appy) pmt. SMUCONTAINMENT gig <br />IL-1. ALARM <br />I <br />❑ 2. BALL FLOAT ❑ 4. EXEMPT <br />0 2. DROP TUBE <br />__ <br />03. STRIKER P p x gin. <br />IV._TANKLEAKOE7ECTION <br />453 IF DOUBLE W ALL TANK O0. TANK WITH BLADDER (Ch 1. Mm oNy). 454 <br />IF SINGLE WALL TANK (Check as that PPly): <br />[:] 1. VISUAL (SINGLE WALLIN VAULT ONLY) <br />0 1. VISUAL (EXPOSED PORTION ONLY) 05. MANUAL TANK GAUGING(MTG) <br />421, CONRNWUSINTERSTITIALMONITORING <br />0 2. AUTOMATIC TANK GAUGING (ATG) Cl S. VADOSEZONE <br />0 3. MANUAL MONITORING <br />0 3. CONTINUOUSATG 07. GROUNDWATER <br />0 4. STATISTICAL INVENTORY RECONCILIATION (SIR) 00. TANK TESTING <br />BIENNIALTANKTESTING 099, OTHER <br />CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE-` <br />V. TANK <br />OF SUBSTANCE REMAINING 458 TANK FILLED WITH INERT MATERIAL7 d 7 <br />ESTIMATED DATE LAST USED (YR/MdOAY) 455 ESTIMATED QUANTITY <br />aallana 0 Yea 0 No <br />Formerly SWRCB Form 8 <br />UPCF (1/99) <br />