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I UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 <br /> fNa rrHlLl <br /> Paige _ d <br /> TYPE OFACNON pH. NEW SITE PERMIT 0 4.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE D <br /> (CheGelsbearey) 0 7. PERMANENTLY CLOSED ON SITE <br /> 03. RENEWAL esson-hw kKa use oVY) cfpeoamydanps-to,/oul us,ow 0 S. TANK REMOVED �14� <br /> PERMIT <br /> BUSINESS NAME(S.As FACILITY NAME or DBA-Doss,Busnaaa As) 3 FACAJTY IDI .. 1 <br /> na ' D?7o? <br /> LOCATION WITHIN SITE(OPW W) tlT <br /> ff o5i55g� oS(�+ r <br /> I.TANK CIVSCRIPT19A <br /> TANKON 432 TANKMANUFACTUR R 433 COMPARTMENTALIZED TANK 15t Yes 0 No 4 <br /> If'Yes%mnPIw one page Iw eacti coma m <br /> Sc-O <br /> DATE_INSTALLED(YEAR/M ) 435 TANK CAPACITY IN 5 438 NUMBER OF COMPARTMENTS 43 <br /> Zolo� � 2- <br /> ADDITIONAL <br /> ADDITIONAL DESCRIPTION(For tool use oNy) 43a <br /> II.TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 40 <br /> v]t. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑ 2_ LEADED ❑ 5. JET FUEL <br /> f1f_maeeC,comooew Petm/aum Type) Op <br /> Is PREMIUM UNLEADED rL 3. DIESEL ❑ B AVIATION FUEL <br /> 02. NONFUEL PETROLEUM <br /> 0 3. CHEMICAL PRODUCT <br /> S(hom Haianlaus Matedats Inventory page) 42 <br /> ❑1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER <br /> 0 4, NAZNaD01JS WASTE(Intludes COMMON NAME(hom Hazamous Matmals Inwdory page) 41 Ca <br /> Used Oa) <br /> 095. UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 0 1_ SINGLE WALL 0 3. SINGLE WALL WTH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 4s, <br /> (Cheat one aeon amy) TY12. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> ! 0 4. SINGLE WALL IN A VAULT ON, OTHER <br /> TANK MATERIAL-ptlmary W9t fit L BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE 13 95. UNKNOWN 444 <br /> (Chat Doe aem only) 0 2. STAINLESS STEEL 0 4. STEELCIAD 0 S. FRP COMPATIBLE W/IW%METHANOL 099. OTHER <br /> WIFIBERGLsSS <br /> sT REINFORCED PLASTIC FRP <br /> TANK MTERIAL-ae IVT uos 0 1 BARE STEEL qa.3. FIBERGLASS I PLASTIC 08, FRP COMPATIBLE W/100%METHANOL 095. UNKNOWN 445 <br /> (Cha,*one ser,only) 0 2. STAINLESS STEEL ❑ A. STEE-CIADWFISERGLASS 0 9. FRP NON-CORROOIBLE JACKET 099 OTHER _ <br /> REIN'ORCED PLASTIC(PAP) 010 COATED STEEL <br /> 0 5. CONCRETE <br /> TANK INTERIOR LINING 1. RUBBER LINED 0 3. EPDXY LINING 05. GLASS LINING 095. UNKNOWN 446 DATE INSTALLED 47 <br /> OR COATING <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING6. UNLINED 1199. OTHER <br /> CherA ane item and Fw Iopl use oN <br /> OTHER CORROSION 0 1. MANUFACTURED CATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 0111 UNKNOWN 48 DATEINSTALLED 49 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT 099. OTHER <br /> (Check one dem onN) ❑ 2. SACRIFICIAL ANODE (Fwloaluse oMyj <br /> SPILL AND OVERFILL o YEAR INSTALLED 450 'PE(Forlool use only) 451 OVERFILL PROTECTION EOUIPME YEAR INSTALLED x`452 <br /> (Check r that ADI y'1. SPILL CONTAINMENT Z6'10aI 0 1. ALARM R'. . FILL TUBE SHUT OFF VALVIIiI <br /> 2. DROP TUBE -LCIb f 0 2. BALL FLOAT 0 4 EXEMPT <br /> 3. STRIKER PLA.L 7 W_�( <br /> a N. TANK LEAK DETECTION <br /> IF 51NGLE WALL TANK!Chock an that aady): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item Dory): 454 <br /> 01. V6:ALtEXPOSED PORTION ONLY) 0 5. MANUAL TA\<GAUGING(MTG) 01. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> 0 2. AUTCMTIC TANK GAUGING ATG) 06 VADOSE ZCnE 92. CONTINUOUSINTERSTMAL MONITORING <br /> 0 3. CONTINUOUS ATG 0 7. GROUNDWATER ❑ 3. MANUAL MONITORING <br /> 0 4. STA-ISTICAL INVENTORY RECONCILIATION(SIR)• 08 TANKTEST NG <br /> B!ENtiiAL TANK TESTING 099, OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIM4TE3-ATE LAST USED NFUM0'CAY) 455 ESTIMATED QUANTITY 5 SUBSTANCE REMAINING 456 TANK FILLED MATH INERT MATERIAL? 457 <br /> galbna 0 Yes 0 No <br /> UPCF(V92I • 0 <br /> Formerly SWRCB Form 6 <br />