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lw <br /> UNIFIEDPROGRAM CONSOLIDATED WRM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> f111 Mn pages par tank) <br /> Page <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE <br /> (Check.,Wm pnN) ❑ T. PERMANENTLY CLOSED ON SITE <br /> Cl 3.RENEWAL PERMIT (Spec#y leasco-farlocal use only) (SPSKSy Margo-for krcal use oMy) <br /> ❑ B. TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACIUTY NAME or OBA-Doug Business As) FACILITY 10 IS 1 <br /> L TION WATHIN SITE(OpBeneq 431 <br /> I.TANK DESCRIPTION <br /> TANKID# TANKMANUFACTURER <br /> Z COMPARTMENTALIZED TANK ❑ Yes ❑ Na <br /> 19M' I <br /> 1f'Yes.complete one page for each acmpamnent. <br /> DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> ADDITIONAL DESCRIPTION(Forlac use onW <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (IT mukaC.compble Peeps.Typal ❑,n. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6.AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM ❑1c MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER <br /> ❑ 3. CHEMICAL PRODUCT <br /> ❑ 4. HAZARDOUS WASTE(lm . COMMON NAME(hom Hasamous Mal9Ml3 lnronfory Page) CAS IS(hem Masa/Bous Materials Imentery paps) <br /> uses Oiq <br /> 099 UNKNOWN <br /> 111.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGIE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Check otra item only) Cl 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> ❑ 4. SINGLE WALL 1N A VAULT <br /> 1199. OTHER <br /> TANK MATERIAL-primary tank ❑ t BARE STEEL ❑ 3. RBERGNSSIPLASTIC ❑ 5. CONCRETE Cl 95. UNKNOWN <br /> (Cheokwreitemonly) ❑ 2. STAINLESS STEEL Cl 4. STEEL CLAD WIFIBERGLASS ❑ B. FRP COMPATIBLE We100%METHANOL IJ 99, OTHER <br /> REINFORCED PLASTIC TRP) <br /> TANK MATERIAL-seconder,tank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PUSTC ❑ B. FRPCOMPATIBLEW1100%METHANOL 095. UNKNOWN <br /> (Chacko/Nrtemonly) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CUD WMISERGLASS Cl 9.FRP NONCCRRODIBLE.1ACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) 1110. COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING ❑ 1. RUBBER UNED ❑ 3. EPDXY LINING ❑ S. GLASS LINING ❑95. UNKNOWN433 DATE INSTALLED <br /> TA COATING <br /> ❑ 2. ALKYD UNING 114. PHENOLIC LINING ❑ S. UNLINED ❑99. OTHER <br /> kOM".only) Fwlacal use an ) <br /> OTHER CORROSION13 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑M. UNKNOWN 434 DATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> (Check.kern may) ❑ 2. SACRIFICIALANODE ❑ 4. IMPRESSED CURRENT 12 0. OTHER <br /> Forlacel use only) <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forbral uss wSW OVERRU PROTECTON EQUIPMENT:YEAR INSTALLED <br /> (Chat apfhetapgy) ❑ 1 SPILL CONTAINMENT ❑ 1.ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> IV. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK(Chack all Inst APPY): IF DOABLE WALL TANK OR TANK WITH BLADDER(C/ k..,mm oMy/: <br /> Cl 1. VISUAL(EXPOSED PORTION ONLY) Cl 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLEWALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VACOSE ZONE Cl 2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTNUOUSATG ❑ T. GROUNDWATER Cl 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑ e. TANK TESTING <br /> BIENNIAL TANK TESTING 13 99. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> FILLED WITH INERT <br /> ESTIMATED DATE/LA/S USED(YRIMO/0AY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK MA.,TER/IAL'/ <br /> '1 I ons ❑Yes IWJO <br /> CUPAFORM(4/99) Fa meNy SWRCB Form B <br />