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MAY-11-2010 11 :24 AM P. 08 <br /> UN' 'D PROGRAM CONSOLIDATED FORM <br /> _ TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br /> two..... er <br /> past—of— <br /> TYPE <br /> or_of ,TYPE OF ACTION 0 1 NEW SITE PERMIT 0 4 AMENDED PERMIT 0 5 CHANGE OF INFORMATION 0 5 TEMPORARY SITE CLOSURE <br /> [] 7 PERMANENTLY CLOSED ON SITE <br /> (Chink on.iron mN7 -- <br /> C3 3 RENEWAL PERMIT Spml nue.- a la d uw only) (Spe'll r..non-Rrl."10no +y) 0 O TANKREMOVED 450 <br /> w7t <br /> E(s.m.ueac¢rry%p(r4f; <br /> a..�nn..A7) I <br /> .fir ,nHIN TH(OWlkn•1AIPtItlN (At the locatioarks shall ha suMalttd to the localagency) <br /> / ANUFACTI7ENTALIZED TANK Yes No 4l4 2. —P`8nfor..`h eanp.am.mD(YEAR/MO) PACITY tNCOMPARTMENTS 417 <br /> N <br /> ADDI AL DP.SCRIPTION(pon lw`i wo only) 4317 <br /> II.TANK CONTENTS <br /> TANK USE 459 `P5�ETRE. <br /> /OLEUM TYPE <br /> Aff 1. MOTOR VEHICLE FUEL R'"' REGULAR UNLEADED 0). LEADED 05, JET FUEL <br /> 17Pmuk`b canpnc P`rtntmm 7yp) C ISPREMIUM UNLEADED 03. DIESEL 06. AVIATION FUEL <br /> 01 NON-FUEL.PETROLEUM 0 so. MIDGRADE UNLEADED [14 GASOHOL 99.OTHER <br /> 03. CHEMICAL PRODUCT COMMON NAMRISn+o'Rux,rdo,mantnda]nwootypw) CAS#IavmHk4dnn.N.SMY.InwmadN.) <br /> 04. HAZARDOUS WASTE <br /> (In`Iudn l'W al7 DO Y {p <br /> C3 95.UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TM O TANK 7 3NOLE WALL 3, SSN1 9WALL WITH 17.1. 91; N—EWALL WITH INTERNAL BLADDER SYSTEM <br /> (Ch.ok oneo oo my) EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> yJl. DOUBLE WALL 1:14. SIGNI.E WALL IN VAULT ❑99. OTHER <br /> TANK MA IAL- eta` link I. BARE STEEL .. FIBERGLAS ASTIC S. CONCRETE 5. UNKNOWN 444 <br /> (chink win Lnn may) 0 2. STAINLESS STEEL 0 4. STEEL CLAD W/FHSEROLASS (]S. FAP COMP7IRr.E W/I0D%METHANOL 099.OTHER <br /> NFORCED PLASTIC(PRP) <br /> TANK MATERIAL-neeandlty wk Q L BARE STEEL 9IBERGLASS/PLASTIC 5. CONCRETE LI 05 UNKNOWN 445 <br /> (Ohmic mels.n only) 02. STAINLESS STEEL 04, STEEL CLAD W/FIBEROLASS L3 It, FRP COMFTMLE W/t00%MF.T5IANOL 099,OTHER <br /> REINFORCED PLASTIC(FRP) 0 10 COATED 877171, <br /> 0 5 CONCRETE <br /> TANK INTERIOR t.INING L RUBBER LINED C3 3.EPDXY LINING C3 5,GLASS LINING 95.UNKNOWN 6 DATE INSTALLED H7 <br /> OR COATING 0 2 ALKYD LINING 0 4 PHENOLIC LINING JR4UNLINED 099 OTHER <br /> (Ch.d a.a.n my) (Far lec.lmE.only) <br /> OTHER CORROSION 0 I MANUFACTUREDCATHODIC 0 3 FtBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN H° OATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE PROTECTION 0 4IMPRESSED CURRENT 0 99 OTHER <br /> (Chukoa.IMnonly) 029ACRIFICIAL ANODE. (Pn locd wo <br /> SPILL.AND OVERFILL YEa-INSTALLFD .5a TYPEOnoaloe.only) 451 OVERFILLPROTECTIONEQUIPMENT!YEARINSTALLED <br /> 45512 <br /> TbnnkMlM Tpty) 0 SPILL CONTAINMENT C31 ALARM ` 'FILL TUBE SHUT OFF VALVE <br /> W2 DROP TUBE 0 2 BALL FLOAT [a 4 EXEMPT <br /> 0 3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(A d4.crlpnm m'N.>onlm6ne pmpm dwl If wtmnnd to w.I``W mno'Y.) <br /> IF SINGLE WALL TANK(ohnd140 ma.p*) a93 IF DOUBLE WALL,TANK OR TANK WITH BLADDER .54 <br /> Check mann only) <br /> ❑I VISI JAL PORTION ONLY) C)S MANUAL TANK GAL GINO(MTO) �./I VISUAL <br /> (SINGLE WALL IN VAULT ON LY) <br /> 02 AUTOMATIC TANK OAIIOINO(ATO) 0OS <br /> 6 VADE ZONE S5I2 CONTINUOUS INTERSTITIAL MONITORING <br /> Cl 3 CONTINUOUS ATG 0 7 GROUNDWATER 0 3 MANUAL MONITORING <br /> 0 41.41-Al ISTICAL INVENTORY RECONCILIATION 0 8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING 0 99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USPO(YR/MOIDAY) 451 ESTIMATED QUAN'DTY OP SUBSTANCE kEMAININO 4% TANK FILLED WITH INERT MATERIALS 457 <br /> gallons Q Yes [3 Na <br /> UPCF(12/99 revised) 10 Formerly SWRCB Form B <br />