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`LFIED PROGRAM CONSOLIDATED' �� WE TAp UNDERGROUND STORAGE TANKS TANK PA G Page_er_ TYPE OF ACTION ❑INEW SITE PERMIT Cl 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE (CMckorc irw ony) ❑ 3 RENEWALPERMIT (5pmfyrearoa-fafk uxmdy) (specify rtasnn-Tor bout use ony) 8 TANK REMOVED 430 ID: - 1 BUSINESS NAME(Someea FACumrNAMEor A-DBDoing Bur'usesa As) 3 FACILITY _ 2 5. 7 c(? N 631 LOCATION WITHIN SITE(oprboaD / t t We 5 - �C 5r 2 O o I.TANK DESCRIPTION (A scaled plot plan with the location 01 the UST system including buildings and landmarks shall be submitted to the local agwcy.) TANK ID# a32 (TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes No 434 If"YBFRO-COMPARTMENTS page ARch wsHmrvmvc DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMMBER OF COMPARTMENTS 43y I UIv X) 6wN 14q ® mN ADDITIONAL DESCRIPTION(F .omy) 43s or brat II.TANK CONTENTS TANK USE 639 PETROLEUM TYPE 440 ❑1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If muhed mek.Pnwkm Type) ❑lb. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL A99.OTHER ,s 7`a [r G © P 03. CHEMICAL PRODUCT COMMON NAME (6omHa:mdous Mmeriala lnvemary page) 441 CAS#(enm Hmmdoua hf-w a Iweorory WBe) 442 ❑4. HAZARDOUS WASTE / (bnc Uscdoio 14 Q Ot-7-f IJ 9 � r 95.UNKNOWN In. �.l ID. TANK CONSTRUCTION i1ROFTANK 1. SINGLE WALL 03. SINGLE WALL WITH L]5. SINGLEWALLW1111MERNALBLADDER SYSTEM 443 I µ-trek ose kerooNY) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ❑2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT _ ❑99. OTHER TANK MATERIAL-Ru® rmlr L BARESTEEL U FIBERGLASS/PLASTIC 05. CONCRETE ❑95: UNKNOWN 444 (Cbmk om kcmooly) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTBLE W/100%METHANOL [199.OTHER i REINFORCED PLASTIC(FRP) TANK MATERIAL-s .dary rook ❑1. BARES'iE ❑3. FBERGLASS/PLASTIC 115. CONCRETE 095. UNKNOWN 445 (Chckarckemonly)N6ur ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FTBERGLASS 08. PRP COMPTBLE W/100%METHANOL 099.OTHER I REINFORCEDPLASTIC(FRP) ❑10.COATED STEEL ❑ 5. CONCRETE 1 TANK INTERIOR I.INWGG ❑L RUBBER LINED [13.EPDXY LINING ❑S.GLASS LINING [395.UNKNOWN 446 DATE INSTALLED 447 OR COATING �)w 0 2 ALKYD LINING ❑4 PHENOLIC MING ❑6 UNLINED ❑99 OTHER ( pal ore ooy) (Check ea ivm ody) 448 448 OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Click om kemooly) ❑2 SACRIFICIAL ANODE (For bcnlux only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(bmlux only) 451 OVERFILL PROTECTION EQUIPMENTNEAR INSTALLED 452 (Check aU Thur apply) ❑1 SPILL CONTAINMENT ❑1 ALARM ❑3 FRI.TUBE SHUT OFF VALVE ❑2 DROP TUBE N /� ❑2 BALL FLOAT ❑4 EXEMPT N O ti E ❑3 STRIKER PLATE IV.TANK LEAK DETECTION(A dacrpdoa Ofdmonirormgµugramshull ke aobmkW m de k a1 ageuy.) IF SINGLE WALL TANK(Ctcek u11 our appy) as3 F OUBLE WALL TANK OR TANK W11R BLADDER 45a �( one kem OMY) 1 VISUAL(EXPOSED PORTION ONLY) !"y'MANUAL TANK GAUGING(MIG) VISUAL(SINGI-E WALL IN VAULT ONLY)❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE TONE CONTQJI OU5INTERSITTIAL MONITORING ❑3CONEINUOUS.ATG_.. ._ _._.___.. -..Q..ZGROLImW.A7FP.__. ._._...-____.. MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑STANK TESTING (SIR) BIENNIAL TANK TESTING, ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 INTIMATED QUANTITY OF SUBSTANCE REMAININGG 416 TANK FII.I.ED WITH INERT MA TERW.R as7 A/ 3 O gallons w z/ r4 y []Y,sX No UPCF(1/99 revised) 173 Formerly SWRCB Form B