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mow <br /> iUNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 146/b3 <br /> vas• _ PI _ <br /> .CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION 1.NEW SITE PERMIT ❑ A.AMENDED PERMIT ❑ ]. PERMANENTLY CLOSED ON SITE <br /> (Gea4 one dempNy) <br /> ❑] aon <br /> .RENEWAL PERMIT (SI-II. -lorlaol use omy) (Sp.cd/tlurpe'krlxaluv°nlY) ❑ S_ TANK REMOVED AO <br /> 1 <br /> FA F <br /> BUSINESS NAME(SamA as FACIUtt NAME or DBA-O°In9 Bui, A.1 <br /> LOCATION WITHIN SITE(Opd:nN) A]1 <br /> -' 1.TANK DESCRIPTION <br /> ANKID r'7 TANK MANUFACTUR COMPARTMENTALIZED TANK ❑ Yu ❑ No <br /> � <br /> &J5 Sl N If Yei,mmpleb ana pale(u eatll wmpaM1+.mc <br /> � NUMBER IF COMPARTMENTS <br /> DATE INSTALLED(YEARMO) TANK CAPACITY IN GALLONS <br /> (97 2 2 dD D <br /> ADDITIONAL DESCRIPTION fF.I4 e--aryl <br /> -II.TANK CONTENTS <br /> TANKUSE 402 PETROLEUM TYPE t I. " ❑ 5. JET FUEL <br /> 1.MOTOR VEHICLE FUEL 1a EGUV.R UNLEADED ❑ S.AVIATION FUEL <br /> p/m Ae4 comport Plaa4,Tr-) PREMIUMUNLEADED 0 g. OTHER <br /> ❑ 2. NON-FUEL PETROLEUM rs( p M RADEUNLEAOED 4 GASOHOL 1 <br /> CAS MfInm NauNaua matt",mrenfory page) <br /> ❑ ]. CHEAUCALPROOUCT <br /> ��J�ffJ CO ON NA (from Nanmoui MaMdab lmnnfarypags) <br /> VI A. NAZAROOUS WASTEi fl /"def <br /> UAHf Oq <br /> 111.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLEWALL ❑ 0. SINGLEWALLYATH ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> (CAeakonedemonlY) F(2. DOUBLE WALL p❑ 1. SINGLE WALL IN A VAULT 099. OTHER <br /> TANKMATERIAL-primary M"A C3 1 BARE STEEL ]. FI9ERGLASS/PLASTIC El 5. CONCRETE <br /> ❑95. UNKNOWN <br /> (Gec4 ene dem aHyl ❑ 2. STAINLESS STEEL ❑ A STEEL CLADWIFIBERGUSS ❑ 3. FRP COMPATIBLE W1100%METHANOL 0 S. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL•fea "W4 [I1 ❑99. OOTHETHER <br /> BARE STEEL 5 FIBERGLASS/PLASTIC C3 9. FRP COMPATIBLE Wl10C%METHANOL ❑93. UNKNOWN <br /> (Cnaak 0w dem OW ❑ 2. STAINLESS STEEL ❑ A STEEL CLAD WIFIBERGUSS ❑ 9. FRP NON.CORROOISLE JACKET <br /> REINFORCED PLASTIC(FRP) 0 1 COATED STEEL <br /> ❑ 5. CONCRETE OATEINSTALLEO <br /> 85. UNKNOYNa]] <br /> TANK INTERIOR LINING ❑ 1. RUBBER UNED ❑ ]. EPDXY LINING ICI 5 GLASS LINING ❑ <br /> OR COATING ❑ A. PHENOLIC LINING ❑ S. UNLINED 099. OTHER (Farloca/me onhl <br /> ❑ Z. ALKYD LINING GTEINSTALLED <br /> (Gec4 om dem on ) <br /> OTHER CORROSION [3 1 MANUFACTUREDCATHOOIC ❑ ]_ FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN A <br /> PROTECTION IF APPUCA3LE PROTECTION ❑ A. IMPRESSED CURRENT 099. OTHER (Forlxal uae onlYl <br /> (Ga°kom iNm aHyl ❑ 2. SACRIFICIAL ANODE QWERFILL PROTECTION EQUIPMENT.YEAR INSTALLED <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Far 4a:Alu»oro}') <br /> (Gec4YlAAf+pPN1 ❑ ❑ 1.ALARM ❑ ]. FILL TUBE SHUT OFF VALVE <br /> 1 SPILL CONTAINMENT <br /> ❑ A. EXEMPT <br /> ❑ 2. DROPTUSE ❑ 2. BALLFLOAT <br /> ❑ S. STRIKER PLATE <br /> N.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER(CAeck one item on ): <br /> ¢SINGLE WALLTANK ap MAIAP F ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY? <br /> ❑ 1, VISUAL(E%POSEED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) �a�/ <br /> ❑ S. VADOSEZONE p Z• CONTINUOUS INTERSTITIAL MONITORING <br /> 2. AUTOMATIC TANK GUGING(ATG) ❑ 2, MANUALMONRORING <br /> ❑ ]. CONTINIKKtS ATG ❑ T. GROUND LATER <br /> ❑ A. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ a. TANKTESTNG <br /> WENNIALTANKTESTING ❑p9. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED PATE LAST USED(YRMOrDAY) ESTIMATED OUANTTY OF SUBSTANCE REMAINING <br /> 35 TANK FILLED WITH INERT MATERIAL? <br /> gagona ❑Yaa ❑No <br /> Fo/melly SWRCB Farm 6 <br /> CUPAFORM(6199) <br />