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a Oslo--? v� UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 1 two pages per tank Pae of TYPE OF ACTION ❑l. NEW SITE PERMIT 03. RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 7. PERMANENTLY CLOSED SITE (Check one item only) ❑ 2. INTERIM PERMIT . AMENDED PERMIT ❑ &TEMPORARY SITE CLOSURE ❑ 8. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME w DBA) FACILITY ID: 1 3 Tesoro West Coast Company, LLC USA ,CC# 68154 LOCATION WITHIN SITE (Optional) 431 I. TANK DESCRIPTION A scaled plot Plan with locations of UST system(s) Including buildings and landmarks shall be submitted to the CUPA or PA. TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes N No 434 XjtC MODERN WELDING If on "Yes', complete e page for each compartment. DATE INSTALLED (YEA ) 5 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 12,000 ADDITIONAL DESCRIPTION (For local use only) 438 11. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If markeo complete Petroleum Type) ❑ 1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ® 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME 441 CAS# 442 (from Haeardcus Materials Inventory page) (from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER ((Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 443 ® 2. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL -primary tank ® 1. BARE STEEL 0 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE 0 95. UNKNOWN ((Check one Item only) ❑ 2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑ B. FRP COMPTIBLE W/1 DO% METHANOL ❑ 99. OTHER 444 REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC 0 5. CONCRETE 95. UNKNOWN ((Check one Item only) ❑ 2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/100% METHANOL ❑ 99. OTHER 445 REINFORCED PLASTIC (FRP) O 10. COATED STEEL TANK INTERIOR LINING ❑ 1. RUBBER LINED 0 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN DATE INSTALLED 447 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99 OTHER 446 (Forlocal use only) (Check one item only OTHER CORROSION 0 1 MANUFACTURED CATHODIC M 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN DATE INSTALLED 448 PROTECTION (IF APPLICABLE) PROTECTION ❑ 4IMPRESSED CURRENT ❑ 99 OTHER 448 (For local use only) Check one Item only) ❑ 2 SACRIFICIAL ANODE SPILL AND OVERFILL (Check all that apply) YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 45Y ® 1 SPILL CONTAINMENT 4097 Z b J} ® 1 ALARM 1997 ® 2 DROP TUBE 4897 Z OD S 02 BALL FLO AT 1997 ❑ 4 EXEMPT ® 3 STRIKER PLATE 1997 11 _l ✓ ❑ 3 FILL TUBE SHUT OFF VALVE IV. TAN K LEAK DETECTION (A description of the mondodng program shall be submitted to the local agency.) IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one Item only) ❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (MTG) ❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING (ATG) 0 6 VADOSE ZONE ® 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 3 CONTINUOUS ATG 0 7 GROUNDWATER D 3 MANUAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR) + BIENNIAL TANK TESTING ❑ 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑ Yes o No OFFICIAL USE ONLY DATE RECEIVED CUPA PA DISTRICT/INSPECTOR UP FORM (1/2000 Version) 1 Formerly SWRCB Form B SBC UST-B.doc