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UNIFIED PROGRAM CONSOLIDATED FORM p i_S`^ 4 TANKS UNDERGROUNDSTORAGETANKS -TANKE 1 �\ql' 01/�}/ 1 lnvo pages per lank) r0 "FYPE OF ACTION ❑1 NEW SITE.PERM]f ❑ 4 AMENDED PERMITPape IChwkorcncmonb) ❑ SCHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE - ' ---- - _ _ ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RFNFWALPERMIT ISporily rcavan rurWatuu•onyl (Spaify nagn-f iucal aoM I BUSINESS NAME IU .FACILITVNAMF wnaA-Winpnruirca.Az) FACILITY ID: y 8T.4NK REMOVED 430 J I LOCATION WITHIN SIT"E(,Mum9 UST adjacent to garage 431 1.TANK DESCRIPTION (A scaled pla plan with the location oflhc UST system including buildings alld landmarks shall be submiltW to TANK ID 432 TANK MANUFACTURER the local egrncy.) ',��;{,(' 2 433 u'"""� O unknown COMPARTMENTALIZED TANK ❑Yes No 434 DATE,INSTALLED YEAR/MOI TANK CAPACITY IN GALL ONS aw uw4:.c-WMe nm lupe Gr crch mminnnem. ( 435 unknown N U MBER OF COM PARTM E NTS 437 500 gallon NA ADDITIONAL DESCRIPTION IFu.loin we only) 43H 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ®1. MOTOR VFHIC'LE FUEL 449 afAurkalmnglnc Pdmkvm Typcl ❑ la. REGULAR UNLEADED [J?. LEADED ❑5. 2Er FUEL ❑lb. PREMIUM UNLEADED ❑3. DIESEL ❑2. NON-FUEL PETROLEUM Cl 6.AVIATION FUEL 13 1.. ONMIDNAME 04. GASOHOL ❑99.O'I'LIER Cl 3. CHEMICOUSWA TF, COMMON NAME. Ifnrm llarudoa. Maeri Nimenro ❑4. HAZARDOUS WA$TF ryrogml '141 CA$p(bum llaivdum Munik lm'rnmry pug<1 442 nrcwd.(i aOal gasoline ❑95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK I. SINGLE WALL 3. SINGLE WALL WITH IChnknrcncm Amy) ❑S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM a43 EXTERIOR MEMBRANE LINER 095. UNKNOWN ❑2. DOUBLE WALL ❑4. SIGNLE WALLIN VAULT ❑99. OTHER TANK MATERIAL-pimay laN I. BARE STEEL ❑3. FlBERGLASS)PLASTIC ❑t. CONCKE"fE IC'k korc inn wlyl ❑2. STAINLESS STEL 95. UNKNOWN 441 E ❑4. STEELCLAD W/FIBERGLASS ❑8. FRP COMI'TIBLF.Wi109"A METHANOL ON-OTHER NEINFORCED PLASTICIFRP) TANK MATERIAL-eeroMary laN I. BARE STEEL 3. FlBERGLASS/PLASTIC 5. CONCRETE. ❑95. UNKNOWN N5 I(7gek ore nem only) ❑2. STAINLESS STEEL 04. STEEL CLAD WIFIBERGLAS$ ❑R. FRP COMPDIBLE W90N/.MEI HANOI 094 OTHEN RFINFORCF.DPL.ASTIC(FRP) ❑IB.COATED STEEL. 115. CONCRETE TANK INTERIOR LINING ❑I.RtIReF.R LINED 3.EPDXY LINING 5.GLASS LINING ❑95.UNKNOWN 4aa DATF INSTALLED 4a7 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ff ICFeck orc hem only) [a'}6 UNLINED ❑99OTHER IFwkwal uac only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ®95 UNKNOWN 448 DATF,INSTALLED -9 PROTFCTIONIFAPPLICABLF. PROTECTION ❑41MPRESSFOCURRENT (0hrk me ncmonlyl ❑2 SACRIFICIAL.ANODE ❑99 OTHER SPILL AND OVERFILL YEAR IN S111LLEDa5n IForlwluaonly) TYPE,I)rcn.nrc ,l 451 OVERPILL FROTEC nON EQUIPMENT:YEAR INSTAI.I,F.D 452 ICFxk.n)MiapDlyl ❑(SPILL CON'I'AINMEN'l' ❑2 DROP TUBE unknown ❑1 ALARM ❑3 FILL TUBE SHUTOFF VALVE. ❑.T STRIKER PLATE. ❑2 BALL FLOAT 04EXEMPT Unknown IV.TANK I,F.AK DETECTION In dnaniplbn olau mondonn IF SINGLE WALL TANKK IChck an rhe) s Proammamu EC 4uhmmm m IM Iwa)apercy.) unknown 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑1 VISUAL(EXPOSED PORTION ONLY) I(T`+'kone Mm mdyl ❑ AL I'ANKGAUGING(M'FG) ❑I VISUAL(SINGLE WALL I. VAULT ONLY)2 AL''rOMAI'IC TANK GAUGING(ATG) ❑a VADOSF.ZONE. ❑1 CON'IIN000S INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑4 STATISTICAL INVEN DORY RECONCILIATION EJ 3 MANUAL MONITORING ❑R TANK TESTING (SIR) BIENNIAL TANK TESTING 0990TH FR IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED ryR'MO/UAY) 455 ESTIMATE.DQUANTITVOFSUBSTANCEREMANING TANK FILLED WITH INERT MATERIAL? 457 unknown 1 45fi 50 gallons gallons ❑Yes ❑ No UPCF(12/99 reviscd) .� Formerly SWRCB Form B