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i 13 <br /> UNIFIED P ROG RAM CON SOLIDATED FORM TANK 1V1 <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 (Nropagespertank) <br /> PageOS _ of <br /> ❑ S.CHANGE OF INFORMATION) ❑ S.TEMPORARY SITE CLOSURE <br /> ❑ 7. PERMANENTLY CLOSED ON SITE kt <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT 4.AMENDED PERMIT 'Ir,_✓'k'1k. <br /> ❑ 8.TANK REMOVED 1 <br /> (Checkone Bemany) charge-brlacal ws°My9 30 \ <br /> [13.RENEWAL PERMIT (Spedfy <br /> meson (Spaay J <br /> FACILITY ID 1 <br /> BUSINESS NAME(Be--es FACILITY NAME or DBA-Doing Bush°ss As) <br /> TION THIN BITE(OpB'an+� <br /> 931 <br /> qbO LTANK DESCRIPTION Yes ❑ No <br /> TANK MANUFACTURER COMPARTMENTALIZED TANK <br /> 11 WaY,mmplata one page N,e,,mmpamnanL <br /> TANK IO% <br /> 1 TA D^ /_g NUMBER OF COMPARTMENTS <br /> 1 °f-� IKl TANK CAPACITY IN WLLONS <br /> OATS INSTALLED(YEARIMO) 7V <br /> ADDITIONAL DESCRIPTION(Forkual use aHyl <br /> IL TANK CONTENTS <br /> 432 PETROLEUMTYPE 2.LEADED ❑ S. JET FUEL <br /> TANK USE - <br /> ❑ta. REGULAR UNL ❑ B.AVIATION FUEL <br /> EADED DIESEL Its <br /> ❑ 1. MOTOR VEHICLE FUEL PREMIUM UNLEADED 3 9%" OTHER <br /> (If maMed,complete Pafmleum Type) 010. � q,GASOHOL <br /> ❑ 2.NON-FUELPETROLEUM [3 lo.MIDGRADE UNLEADED CAB#(hom Hazardous Mele4a13lnwnlorypege) <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME(bom Hennfous MalenNs Innnfory Aege) <br /> 4 ODUS WASTE <br /> setl O <br /> MIL TANK CONSTRUCTION <br /> ❑ 3.SINGLEWALLWITN ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> TYPE OF TANK ❑ L SINGLE WALL EXTERIOR MEMBRANE UNER r'IA- UNKNOWN <br /> (Chock one item orM ❑ 2. DOUBLE WALL ❑ 4.SINGLE WALL IN A VAULT 10 89.OTHER <br /> 5. UNKNOWN <br /> ❑ 3. FIBERGLASS I PLASTIC ❑ S.CONCRETE g9 OTHER <br /> TANK MATERIAL-primary lank 1_ BARE STEEL [1 q. STLC D WIFIBERGLASS [3B. FRPCOMPATIBLE WI100%METHANOL <br /> ' EELA <br /> (Check a"Item Only) ❑ 2. STAINLESS STEEL REIN FORCED IC(FRP) 95. UNKNOWN <br /> TANK MATERIAL-5 Wndar7 rank 0 1 BARE STEEL <br /> [13. FIBERGLASS I PLASTIC ❑ B. FRP COMPATIBLE W11011%METHANOL X89. OTHER <br /> ❑ 9.STEEL CLAD WIfIBERGLA55 El 9.FRP NON-CORRODIBLE AC <br /> KET(Check one Hem anIA ❑ 2. STAINLESS STEEL RE IN FORCED PLASTIC(FRP) 10.COATED STEEL <br /> ❑ S.CONCRETE UNKNOWN433 EPDXY LINING DATE INSTALLED <br /> ❑ ❑ 5.GIABS LINING �85. <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED S. ❑ e. DNl1NED ❑99. OTHER Forlocel uss on <br /> OR COATING q ALKYD LINING [34. PHENOLIC LINING PATE INBTALLED <br /> El <br /> UNKNOWN <br /> S4 <br /> ChconHama [1 3. FIBERGLASS REINFORCED PUSTIC H9. OT <br /> OHER CORROSION ❑ 1. MANUFACTUREDCATHODIC 34 <br /> _(F.11-1 --*) <br /> PROTECTIONIFAPPUCABLE PROTECTION ❑ 4.IMPRESSEDCURRENT <br /> (Check one item ORW ❑ 2. SACRIFICIALANODE TYPE(Forlacaluseany) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> YEAR INSTALLED <br /> SPILL AND OVERFILL 0 1.ALARM ❑ ;, FILL TUBE SHUT OFF VALVE <br /> IF an that appy) t. SPILLCONTAINMENi -- <br /> -_ ❑ 2. BALL FLOAT- [1 4. EXEMPT <br /> ❑ 2. DROPTUBE <br /> ❑ 3. STRIKER PLATE <br /> N.`iANK LEAKDETECTK)N ' . <br /> If DOUBLE WALL?ANN OR TANK WITH BLADDER Chock one item On ): <br /> IF SING LE WALL TANK Chet IN,Mal ap F S. MANUALTANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> ❑ 1• VISUAL(EXPOSED PORTION ONLY) C] S VADOSEZONE ❑ 2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) [2 7 GROUNDWATER ❑ 3. MANUALMON90RING <br /> ❑ 3. CONTINUOUS ATG 8. TANKTESTING <br /> ❑ / STATISTICAL INVENTORY RECONCILIATION(SIR)+ <br /> BIENNIALTANKTESTING ❑B9. OTMER-� <br /> V.TANK CLOSURE INFORMATION 1PERMANENT CLOSURE IN 5 TANKMULE TIN INERT MATERIAL? <br /> ESTIMATED DATE UST USED(YH/MOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br /> q+ibna - ❑Yes ❑No <br /> Forrnelfy SWRCB FOM <br /> CUPAFORM(4)99) _ <br />