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+ L- TANK: TA0438304 FIED PROGRAM CONSOLIDATED FORM L U PFI PR0234383 UNDERGROUND STORAGE TANKS--TANK PAGE i FAC#: FA0003670 (two pages per tank) Page 4 of5 TYPE OF ACTION ❑ INEW SITE PERMIT ❑ 4AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chale m0y iam only) ❑ 7 PERMANENTLY CLOSED ON SITE (Spgafy rcnson torlaal use odJ tSPaiyrcaso° for local mconry) ❑STANK REMOVED 430 ❑3 RENEWAL PERMIT FACILLITY ID: PR#: I BUSMESSNAME(Sam°as FACUWNAMEmDBA-Doivg Bminms As) 3 PR0234383 LINDEN ASSOCIATED GROWERS FA0003670 431 LOCATION WITHIN SITE(Opriomp 14175 E HWY 26,LINDEN PHONE I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subsldtted at the local agency.) TANK ID# Tank#: 4 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK []Yes ❑No 434 TA0438304 IVYe;',emmlelemupagermmchmmp,mnmt DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3/1/1992 10.500 / DIESEL TI O 438 ADDITIONAL DESCRIPTION(For lows me only) 3/13/00 CUING PE FR 2315 TO 2360 PER TISH.LBR D.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 610 ® 1.MOTOR VEHICLE FUEL ® Ia.REGULAR UNLEADED ❑ 2.LEADED ❑ S.JET FUEL (Irm,o,, plmepmvlemn TWc) ❑ Ib.PREMIUM UNLEADED ® 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ lc.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(boom Hammum MmmmlI lmmm° Pp c) 441 CAS4(6mm H..ok,.Malmieb lmmsoy page) 442 ❑4.I IA].ARDOUS WASTE Io,luda WodoiO ❑ 95.UNKNOWN ID.TANK CONST RUCTION ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 463 TYPE OF TANK EXTERIOR MEMBRANE LINER 95.UNKNOWN (CLeeI.kmle Ionly) ❑ ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 4a (Chink mm itmmuY) ❑ 2.STAINLESS STEEL ® STEELCLADW/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary lank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN a5 (Cheekcaimn mtlY) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE 447 TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED O�RaCOAT�Gny) ❑ 2ALKYDLINING F14PHENOLIC LINING ®6 UNLINED [399.OTHER (Fmlaalmeody) H9 OTHER CORROSION ❑ I MANUFACTURING CATHODIC M 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Fm-].I.only) (Cheekaa nvn°dy) ❑ 2SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLE450 TYPE(Iaalnmonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Checkall that appy) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VOL` ❑ 2 DROP TUBE 2 BALL ❑ 4 EXEMPT ❑ 3STRIlCER PLATE FLOAT IV.TANK LEAK DETECTION(A,,miptim ofthe mo itming program sball be submitted to the lout agmet) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 IF SINGLE WALL TANK(Cheek all mat oPI (Chink one itmn only) ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ❑2 AUTOMATIC TANK GAUGING(ATG) Fl NODOSE ZONE J-] 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3CONTIN000S ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING C]99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YWMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)