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MC — I1-2010 11 : 23 PTM P _ 06 <br /> U.^ 'ED PKUUKAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br /> (two PNIcs Pw tank <br /> Pw <br /> TYPE Or ACTION LT t NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION C3 6 TEMPORARY SITE CLOSURE <br /> (C km.irommy) _ _ ,_ Cl 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (Speely noon-am l«YSae mly) (Sorely Heron-Por holo.only) 0 S TANKREMOVED 440 <br /> BUSINESS NAME(Sem.FACILDYN «DBA-Niq Bwheh AeFAC—r ID: ^ <br /> 4106 N T$ P-�3 ' CA a a r� 2023 a <br /> LOCATION WITHIN SITE(OP�) 411 <br /> jpeao r-L. L'bwgx,s CJ <br /> L TANK DESCRIPTION (A scaled plot plan with the loeabon of a I18T 6ye6N11 including buk AiBR and Iandlnarks shell be submitted to the[me]agency.) <br /> TANK ID# w 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Ya No 434 <br /> V i5G If"yw"emnvNw enepyp Rennwr�a� <br /> r.nenm <br /> DATE STALLED(YEAR/MO) 435 TANK CAPACITY 1N GALLONS 435 Ni.1MBF.R OF COMPARTMENTS m7 <br /> L 666 <br /> ADDITf AL <br /> DESCRIPTION(F.kw ..my) 1a33 <br /> IL TANK CONTENTS <br /> �y TANK USE 39 PETROLEUM TYPE 4m <br /> MOTOR VEHICLE FUEL Q It. RF.OUI.AR UNLEADEDD 2. LEADED [15.. IETFUEL <br /> R[mvketl eomplem PeknleUm Trpe) GI,, PREMIUMUNLE .1 <br /> ADED DIESEL 06, AVIATION FUEL <br /> ❑2. NON-FURL PPTROLEISM C3 It. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER <br /> 0 CHEMICAL PRODUCTCOMMON NAME (ft.ll...rdae Mr.ndstnvnnary W.) MI CA$#(Onm Reeprdp MMM.I.amnwy P.an) <br /> ❑4. HAZARDOUS WASTE <br /> w) Fab <br /> ❑95.UNKNOWN <br /> TIL TANK CONSTRUCTION <br /> TYPE OF TANK U 1. SINGLE ALL u). SINGLE WALT,WTTR L]S. 5 LF,WALL wtTH INTERNAL HLADDERS <br /> (Ck«4 mm lwm«y) EXTERIOR MEMBRANE LINER 096. UNKNOWN <br /> DOUBLE WALL [14 SIONLE WALL IN VAULT C199 OTHER <br /> T KMA IA -pimmywnk rjI BARFITEtt, FIBERGLA rPLAST 5. CONCRETE . UNK14OWN 444 <br /> (Ch«kon iwm mly7 ❑2. STAINLESS STEEL 114. STEEL CLAD W/FIBERGLASS 0D. FRP COMPTIBLE W1100%METHANOL 099.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> rANkMAttkIAL eeawde,.k L11 BARD. FIBERGLASS/PLASTIC 5. CONCRETE 5. <br /> (CA«k M.k.only) Q2. STAINLESSSTEEL 4. STEEL CLAD W/FIBERGLASS C36. FRPCOMPTt3LF.W/100%ME7HA1,IOL ❑,,.OTHER <br /> REIYFORCED PLASTIC(FRP) Cl 10.COATED STEEL <br /> ❑5. CONCRETE <br /> TANK INTERIOR LINING 0I.RUBBERLINED U 3,EPDXY LINING 0 J.GLASS LINING 95.UNKNOWN 446 DATSINSTALLED 4 <br /> OR COATING ❑2 ALKYD LNING ❑4 PHENOLIC LINING *1 UNLINED ❑99 OTHER <br /> (Chink—irmudy) Me IurY m mly) <br /> OTHER CORROSION ❑1 MANUFACTURE,')CAtHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN dM DATE INSTALLED N9 <br /> MOTEC ION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER <br /> K%.kmwk4mmly) O 2 SACRIFICIAL ANODE (Fm kwYwwdy3 <br /> SPILL AND OVERFILL. WAR INSTALLSO 450 TYPE(hw--*) 411 OVERF%I'PROTECTIUN 6QWPMB'NT:YEAR INSTALLED 451 <br /> (Ckmk el ro e ropy) 01 SPILL CONTAINMENT 0i ALARM 44}11"ILL TUBE SHUT OFF VALVE <br /> X"2 DROP TUBE Q 2 HALL FLOAT ❑4 EXEMPT <br /> ❑3 STRIKER PLATE <br /> IV,TANK LEAK DETECTION(AdmvI,,heA ofthe Ael n.namm.4 w dor Iotd v wj <br /> IF SINGLE WALL TANK(e k dl the m,py) 453 IF DOABLE WALL TANK OR TANK WITH BLADDER 4% <br /> LCn«k m.uem my) <br /> [31 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTO) 61 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATO) ❑6 VADOSE TANS NTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATO ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> Q 4 STATISTICAL INVENTORY RECONCILIATION ❑R TANK TESTNO <br /> (SIR) BIENNIAL TANR.TBSTINO 0 9 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 1 F,STIMATED QUANTITY OF SUBSTANCE REMAINING 416 TANK FILLED WITH INERT MATERIAL, 4 7 <br /> gallons ❑Yu ❑ No <br /> UPCF(17/99 revised) 10 Formerly SWRCB Form B <br />