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r I �Inlsl 7, 'qw UNIFIED PROGRAM CONSOLIDATED FORM TANKS v / UNDERGROUND STORAGE TANKS - TANK PAGE 1 (Two pages per tank) Page _ of_ TYPE OF ACTION ❑ 1. NEW PERMIT ❑ 4. AMENDED PERMIT QI 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY TANK CLOSURE 430. (Clock one gem only) ❑ 3. RENEWAL PERMIT /" ❑ 7. PERMANENTLY CLOSED ON SITE (Specltyono.) (Spccifyoas ) ❑8. TANK REMOVED BI]$.�I $$NAME(Same aaFACILITY NAME orDBA-Doing Business As) 3, FACILITY ID: I L /rte 3 9 LOCATION WITHIN SITE (Op' oral) 031. 8.103 Gri►St I 0C c.G�,vCr1. llss7 Sim 6uyl/,N I. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local TANK ID # 432. TANK MANUFACTURE 433. COMPARTMENTALIZED TANK es El No 434. n A/ ' / lld 0ryey/a �/y If "Yea. complete one page for each compatonent. DATE INSTALLED 433, TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 43]. (YEARJMO) aq z; Alum 3 ADDITIONAL DESCRIPTION (Fm local nsn only) 438. .1 Wa 6"l- &N4*; 'T.uE U4`0 N II44-79Z H. TANK CONTENTS TA USE 439. PETROLEUM TYPE 4ao. I. MOTOR VEHICLE FUEL❑� REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL ufcecked. complete Parok. Type) �Ia. bib PREMIUM UNLEADED 03. DIESEL [j 6. AVIATION GAS ❑ 2. NON -FUEL PETROLEUM ❑ ]c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER. ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Matenalslaventorypege) 4q1' CAS#(from Haaafdona NIneflah Nvenaxypage) 442. ❑ 4. HAZARDOUS WASTE (Includes USW Oil) Q / ❑ 95. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL [13. SINGLE WALL WITH EXTERIOR ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check we item only)/ MEMBRANE LINER ❑ 95. UNKNOWN 2'2 DOUBLE WALL [14. SINGLE WALL IN A VAULT ❑ 99. OTHER _ TANK MATERIAL - primary lank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC F-1 5. CONCRETE ❑95. UNKNOWN 444. (Chock one item only) ❑2. STAINLESS STEEL 84. STEEL CLAD W/FIBERGLASS C3 8. FRP COMPATIBLE El 99. OTHER: REINFORCED PLASTIC PRP W/100%METHANOL TANK MATERIAL -secondary tank ❑I. BARE STEEL ❑3. BERGLASS/PLASTIC ❑ 8. FRP COMPTBLE W/100%METHANOL ❑95. UNKNOWN 445. (Check we item only) [12. STAINLESS STEEL STEEL CLAD W/FBERGLASS ❑ 9. FRP NON-CORRODABLE JACKET [199. OTHER REINFORCED PLASTIC (PRP) ❑ 10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446. DATE INSTALLED 07. OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6. UNLINED [199. OTHER Check we item cal OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑ 95. UNKNOWN 448, DATE INSTALLED 449. PROTECTION PROTECTION [14. IMPRESSED CURRENT [199. OTHER If Applicable) ❑ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YE INSTALLED 450. 'WE X 451. OV FILL PROTECTION EQUfpMENT: YEAR INSTALLED 452. (Check all that apply) SPILL CONTAINMENT - Y1 W [i�j ALARM _ Jr.FILL TUBE SHUT OFF VALVE DROP TUBE 7- Dlou ❑ 2. BALL FLOAT ❑ 4. EXEMPT Er3. STRIKER PLATE Al fhL IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all [hat apply) (Check one item only) ❑ 1. VISUAL (EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MTG) ❑❑ 11.. VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING (ATG) ❑ 6. VADOSE ZONE &TCONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG [17. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION ❑ S. TANK TESTING (SIR)+ BIENNIAL TANK TESTING F1 99. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456' TANK FILLED WITH INERT MATERIAL? 457' Salinas ❑ Yes ❑ No UPCF hwfwm-b (1/99) -1/4 www.unidocs.org Rev. 02/16/00