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a <br />UNIFIED PROGRAM (UP) FORM <br />UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br />two pages pertank Pae of <br />TYPE OF ACTION D1. NEW SITE PERMIT 03. RENEWAL PERMIT D 5.CHANGE OF INFORMATION D 7.PERMANENTLY CLOSED SITE <br />(Check one item only) O 2. INTERIM PERMIT t3-4. AMENDED PERMIT D 6.TEMPORARY SITE CLOSURE D 8. TANK REMOVED 430 <br />BUSINESS NAME(Same as FACILITY NAME or DBA)3 <br />FACILITY ID: <br />1 <br />Tesoro West Coast Company, LLC USA ,CC# 68154 <br />$- <br />LOCATION WITHIN SITE (opaona0 431 <br />I. 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 />TANKID# --_� 43z TANK MANUFACTURER 433 <br />COMPARTMENTALIZED TANK Yes No 434 <br />'� 5 MODERN WELDING <br />"'Yes', complete one pageforeach compartment. <br />DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 <br />NUMBER OF COMPARTMENTS 437 <br />6,000 <br />2 <br />ADDITIONAL DESCRIPTION (For local use only) 438 <br />II. TANK CONTENTS <br />TANK USE 439 <br />PETROLEUM TYPE 440 <br />® 1. MOTOR VEHICLE FUEL <br />[Ila. REGULAR UNLEADED D 2. LEADED D 5. JET FUEL <br />(If marked complete Petroleum Type) <br />01b. PREMIUM UNLEADED D 3. DIESEL D 6. AVIATION FUEL <br />[12. NON -FUEL PETROLEUM <br />D 1c. MIDGRADE UNLEADED D 4. GASOHOL D 99. OTHER: <br />D 3. CHEMICAL PRODUCT <br />COMMON NAME 441 <br />CAS# 444 <br />(from Hazardous Materials Inventory page) <br />(from Hazardous Materials Inventory page) <br />❑ 4. HAZARDOUS WASTE (includes Used Oil) <br />D 95. UNKNOWN <br />III. TANK CONSTRUCTION <br />TYPE OF TANK D 1. SINGLE WALL D 3. SINGLE WALL WITH D 5. SINGLE WALL WITH INTERNAL BLADDER <br />((Check one item only) EXTERIOR MEMBRANE LINER D 95. UNKNOWN 443 <br />® 2. DOUBLE WALL 04. SIGNLE WALL IN VAULT D 99. OTHER <br />TANK MATERIAL -primary tank ® 1. BARE STEEL 03. FIBERGLASS / PLASTIC D 5. CONCRETE D 95. UNKNOWN <br />((Check one item only) D 2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS D 8. FRP COMPTIBLE W/100% METHANOL D 99. OTHER 444 <br />REINFORCED PLASTIC (FRP) <br />TANK MATERIAL -secondary tank D 1. BARE STEEL D 3. FIBERGLASS / PLASTIC D 5. CONCRETE [195. UNKNOWN <br />(Check one item only) D 2. STAINLESS STEEL ® 4. STEEL CLAD W/FIBERGLASS D 8. FRP COMPTIBLE W/100% METHANOL D 99. OTHER 445 <br />REINFORCED PLASTIC (FRP) D 10. COATED STEEL <br />TANK INTERIOR LINING D 1. RUBBER LINED D 3. EPDXY LINING D 5. GLASS LINING 0 95. UNKNOWN <br />DATE INSTALLED 447 <br />OR COATING D 2 ALKYD LINING D 4 PHENOLIC LINING ® 6 UNLINED D 99 OTHER 446 <br />(For local use only) <br />(Check one item only) <br />OTHER CORROSION D 1 MANUFACTURED CATHODIC D 3 FIBERGLASS REINFORCED PLASTIC D 95 UNKNOWN <br />DATE INSTALLED 448 <br />PROTECTION (IF APPLICABLE) PROTECTION D 4 IMPRESSED CURRENT D 99 OTHER 448 <br />(For local use only) <br />Check one item only) D 2 SACRIFICIAL ANODE <br />SPILL AND OVERFILL <br />(Check all that apply) <br />YEARINSTALLED 450 <br />TYPE (local use only) 451 <br />OVERFILL PROTECTION EQUIPMENT <br />YEAR INSTALLED 452 <br />® 1 SPILL CONTAINMENT <br />9997' t ) I <br />®1 ALARM 1997 <br />® 2 DROP TUBE <br />2 BALL FLOAT 1997 <br />® 3 STRIKER PLATE <br />1997 <br />D 3 FILL TUBE SHUTOFF VALVE <br />D 4 EXEMPT <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 <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br />(Check one item only) <br />D 1 VISUAL (EXPOSED PORTION ONLY) D 5 MANUAL TANK GAUGING (MTG) <br />D 1 VISUAL (SINGLE WALL IN VAULT ONLY) <br />D 2 AUTOMATIC TANK GAUGING (ATG) D 6 VADOSE ZONE <br />® 2 CONTINUOUS INTERSTITIAL MONITORING <br />D 3 CONTINUOUS ATG D 7 GROUNDWATER <br />D 3 MANUAL MONITORING <br />D 4 STATISTICAL INVENTORY RECONCILIATION D 8 TANK TESTING <br />(SIR)+BIENNIAL TANK TESTING 099 OTHER <br />V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (YR/MO/DAY) 455 <br />ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 <br />TANK FILLED WITH INERT MATERIAL? 457 <br />D Yes D 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 />