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• �b��� 10 -7 2urz <br />UNIFIED PROGRAM (UP) FORM <br />UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br />(two pages pertank Pae of <br />TYPE OF ACTION 01. NEW SITE PERMIT 03. RENEWAL PERMIT 0 5.CHANGE OF INFORMATION 0 TPERMANENTLY CLOSED SITE <br />(Check one Rem only) 0 2. INTERIM PERMITET 4. AMENDED PERMIT 0 6.TEMPORARY SITE CLOSURE 0 8. TANK REMOVED 430 <br />BUSINESS NAME (SameasFACILITY NAME orDBA) <br />FACyI YID:' <br />1 <br />Tesoro West Coast Company, LLC USA ,CC# 68154 <br />3 <br />�y <br />LOCATION WITHIN SITE (Optional) 431 <br />1. TANK DESCRIPTION <br />A scaled plot plan with locations of UST system(s) including buildings and landmarks shall be submitted to the CUPA or PA. <br />TANK ID # 482 <br />rg�5p4$D.3 <br />TANK MANUFACTURER 433 <br />COMPARTMENTALIZED TANK Yes No 434 <br />MODERN WELDING <br />If 'Yes', complete one page for eachcomperknent. <br />DATE INSTALLED ( EARIMO) 495 <br />TANK CAPACITY IN GALLONS 439 <br />NUMBER OF COMPARTMENTS 437 <br />12,000 <br />ADDITIONAL DESCRIPTION (For local use only) 438 <br />11. TANK CONTENTS <br />TANK USE 439 <br />PETROLEUM TYPE 440 <br />® 1. MOTOR VEHICLE FUEL <br />01a. REGULAR UNLEADED 0 2. LEADED 0 5. JET FUEL <br />(R marked complete Petroleum Type) <br />01b. PREMIUM UNLEADED 03. DIESEL O6. AVIATION FUEL <br />Cl 2. NON -FUEL PETROLEUM <br />0 ,c. MIDGRADE UNLEADED 0 4. GASOHOL 0 99. OTHER: <br />0 3. CHEMICAL PRODUCT <br />COMMON NAME 441 <br />CAS# 442 <br />(from Hazardous Materials Inventory page) <br />(from Hazardous Matenals Inventory page) <br />0 4. HAZARDOUS WASTE (Includes Used Oil) <br />0 95. UNKNOWN <br />111. TANK CONSTRUCTION <br />TYPE OF TANK 1. SINGLE WALL Ll 3. SINGLE WALL WITH D 5. SINGLE WALL WITH INTERNAL BLADDER <br />((Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 443 <br />0 2. DOUBLE WALL [14. SIGNLE WALL IN VAULT 0 99. OTHER <br />TANK MATERIAL - primary tank 01. BARE STEEL 03. FIBERGLASS/PLASTIC 0 5. CONCRETE 095. UNKNOWN <br />((Check one Item only) 0 2. STAINLESS STEEL 0 4. STEEL CLAD W/FIBERGLASS 0 8. FRP COMPTIBLE W/100% METHANOL 0 99. OTHER 444 <br />REINFORCED PLASTIC (FRP) <br />TANK MATERIAL -secondary tank 0 1. BARE STEEL 03. FIBERGLASS / PLASTIC 0 5. CONCRETE 0 95. UNKNOWN <br />((Check we item only) [12. STAINLESS STEEL I& 4. STEEL CLAD W/FIBERGLASS [18. FRP COMPTIBLE W/100% METHANOL 0 99. OTHER 445 <br />REINFORCED PLASTIC (FRP) [110. COATED STEEL <br />TANK INTERIOR LINING M 1. RUBBER LINED 0 3. EPDXY LINING 0 5. GLASS LINING [196, UNKNOWN <br />DATE INSTALLED 447 <br />OR COATING 0 2 ALKYD LINING 0 4 PHENOLIC LINING 0 6 UNLINED 0 99 OTHER 446 <br />For local use only) <br />(Check we Item only) <br />OTHER CORROSION 0 1 MANUFACTURED CATHODIC 0 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN <br />DATE INSTALLED 448 <br />PROTECTION (IF APPLICABLE) PROTECTION 0 4 IMPRESSED CURRENT 0 99 OTHER 448 <br />(For local use only) <br />Check one item only) 0 2 SACRIFICIAL ANODE <br />SPILL AND OVERFILL <br />(Check all that apply) <br />YEAR INSTALLED 450 <br />TYPE (local use only) 451 <br />OVERFILL PROTECTION EQUIPMENT YEAR <br />INSTALLED 452 <br />N 1 SPILL CONTAINMENT <br />1997'p <br />20 S <br />0 ALARM 1997 <br />N 2 DROP TUBE <br />) <br />,997 Zp0 S <br />02 BALL FLOAT 1997 <br />0 3 STRIKER PLATE <br />1997 <br />0 3 FILL TUBE SHUT OFF VALVE <br />0 4 EXEMPT <br />IV. TANK LEAK DETECTION (Adeaaiption of the monitoring program shall be submitted to the local agency.) <br />IF SINGLE WALL TANK (Check all that apply) 453 <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br />(Check one item only) <br />0 1 VISUAL (EXPOSED PORTION ONLY) 0 5 MANUAL TANK GAUGING (MTG) <br />0 1 VISUAL (SINGLE WALL IN VAULT ONLY) <br />0 2 AUTOMATIC TANK GAUGING (ATG) 0 6 VADOSE ZONE <br />0 2 CONTINUOUS INTERSTITIAL MONITORING <br />0 3 CONTINUOUS ATG 0 7 GROUNDWATER <br />0 3 MANUAL MONITORING <br />0 4 STATISTICAL INVENTORY RECONCILIATION 0 8 TANK TESTING <br />(SIR) + BIENNIAL TANK TESTING 0 99 OTHER <br />V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (PRIMO/DAV) 455 <br />ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 <br />TANK FILLED WITH INERT MATERIAL? 457 <br />0 Yes 0 No <br />OFFICIAL USE ONLY DATE RECEIVED CUPA PA DISTRICT/INSPECTOR <br />UP FORM (1/2000 Version) 1 Formerly SWRCB Form B <br />SBC UST-B.doc <br />