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WHIED PROGRAM CONSOLIDATED FAIN,--- & /03 T <br />UNDERGROUND STORAGE TANKS -TANK PAGE 1 N <br />l!5_63 7 <br />74 Of (two pants per hnk) <br />haa_d <br />TYPEOFACrION 01NEWSITEPERMIT K6 AMENDEDPERMIT 0 SCHANOBOFBJFORMATION 0 6 TEMPORARY SITE CLOSURE Ib <br />(Chxk w hm WY) 0 7 PERMANENTLY CLOSED ON SITE <br />0 J RENEWAL PERMIT (Spft�-sar"mall) O t TANK REMOVED <br />BUSINESS NAME(&=w7AC9MXOAEarD8A-De6ia%&mAs)A <br />I <br />D: <br />1 <br />0fL t D P'iiriz a L� V 1^^ <br />I.00AA WITHM SITE VJp.) 431 <br />ANK DESCRIPTION (A scaled Plot pan WI the JoegUm of the UST system mcluding buiidhW and landmarks shall be sabmutted to the local agency.) <br />Og/5G37 a2 <br />TANK ID�1M <br />TANK M,ANUFACIl1RER, �v <br />COMPARTMENTALIZED TANK Yu No N>r <br />�. <br />' /Fi L� <br />lM 0'(,, e rj, �( W 1 <br />D'Ya'.—Od me pw fa ahm�pranwa <br />DATE STALL Fn IY 0) as <br />TANK CAPA ITY NS <br />BER OF COMPARTMENTS o7 <br />CL C 3 <br />/O o00 <br />`3 <br />ADDITIONAL DESCRIF I IUN Ra iod s air) 4M <br />I4 TANK CONTENTS <br />sa <br />TANK USE atv PETROLEUM TYPE <br />di. UOTOR VEFUCLF FUEL Ej 1a. REGULAR UNLEADED [12- LEADED 0 5. YET FUEL <br />(IferArl a.yLa lad®TYPO 0 M PREMIUM UNLEADED 0J. DEESE, 06 AVIATION FUEL <br />01. NONFUE. PETROLEUM 01c MIDGRADE UNLEADED 0N. GASOHOL. 0P9. OTHER..... <br />0 ]. CHEMICAL PRODUCT COMMON NAME (6® wam. W --b d^aa<rPw) 1 CAS4 (6® H..d . M+vol. k.w y pw) u2 <br />0 A. HAZARDOUS WASTE <br />(rd.eo V.W W) <br />0 95. UNKNOWN <br />III. TANK CONSTRUCTION <br />T 1. SINGLE WAIL 3. SINGLE W 5. SING ALL. WIT15: BLADDER SYSTEM 443 <br />EXTERIOR MEMBRANE LINER 095. UNKNOWN <br />to.* 6. .1y) <br />Q2. DOUBIEWALL. 0 N. RIGNLE WALLIN VAULT 099. OTHER..... <br />TFRIAL_v�r•� 1. BARE SIPFiL J. FR S. CONCRETE95. UNKNOWN <br />STEEL 06. SIffi. CLAD WIFBEtGLASS 0 L FRP COMPTIBLE W1100% METFIANOL 099. OTHER ..... <br />(Odes adr) 02. STAMM <br />REINFORCED PLASTIC (FRP) <br />_�ed.7 enF t.ARE J. FA CONCRETE 95. IIJUONOWN HS <br />02 STAINLESS STEEL ❑l STEEL CLAD WWMERGLASS 0a. FRP COMPETEIE W/I00%1.¢TIUANOL ❑99.OTHER .... <br />(O.*as Ya aM <br />REINFORCED PLASTIC (FRP) 0 10. COATED STEEL <br />0 S. CONCRETE <br />w7 <br />95. DATE INST <br />1. Flt 1 <br />OR COATING 0 2 ALKYD LDB+G 0 N PHENOLIC LI ING kj 6 UNLINED 0 "OTHER .. _ .. • • .. (� local ac ody) <br />(Ord: es to do µP <br />OTHER CORROSION 0 1 MANUFACIURED CATHODIC 0 S FIDE G A.SS REINFORCED PLASTIC 0 95 UNKNOWN <br />TION IF APPLICABLE PROTECTION C]a DAPRFSSED CURRENT ❑ 99 OTHER <br />PROTECCT (fvlod s dy) <br />(O.d st.a a.w 02 SACRIFICIAL. ANODE s2 <br />E MENT: DNSP <br />�. E 1. e•b'1 Ii; T i, 1101. P-0TRWil <br />(Cr .&"wpiy) 141SPILCONTAINMFNT I ALARM CZ- O J FBI. TUBE SHUT OFF VALVE..... <br />[g 2 DROP TUBE O (R2 HALL FLOAT . C ?! 0 t EXE PT <br />3 STRIKER PLATE _ A?_! .. .. <br />N. TANK LEAK DETECTION U Awe da. F�os�.h.m be.abmimd n d.l.ol.ae.ry.) <br />NT F DOUBLE WAIL TANKOR TANK WITH BLADDER <br />IF SINGLE WALL TA K(od slldr wlr) (Chert ase kw **) <br />01 VISUAL (EXPOSED PORTION ONLY) 05 MANUAL TANK GAUGING(MTG) 01 VISUAL (SINGLE WALL IN VAULT ONLY) <br />0 2 AUTOMATIC TANK GAUGING (ATG) 0 6 VADOSE ZONE K2 CONTINUOUS INTERSTITIAL MONITORING <br />0 J CONTINUOUS ATG ❑ 7 GROUNDWATER 0 J MANUAL MONITORING <br />0 4 STATISTICAL INVENTORY RECONCILIATION 0 a TANK TESTING <br />(SIR) BIENNIAL TANK TESTING 0 99 OTHER . _ , _ _ <br />IV. TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE S <br />DATE LAST USED (YR/MO/DAY) <br />ESTIMATED QUANTITY OF SUBSTANCE R04AMM <br />TANK FILLED WITH INERT MATFRLAL7 <br />FSIIAATED <br />gaRom <br />❑ Yes ❑ No <br />UPCF (1199 revised) 10 Formerly SVrRCB Form B <br />