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1 IED PROGRAM CONSOLIDATED FOI . �,/ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page 29 pf43 TYPE OF ACTION ❑ I NEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) ® ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT ❑ 8TANK REMOVED 430 BUSINESS NAME(same a FACILITY NAME m DBA-Doing III III , As> 3 FACILITY ID: 1 AMERICAN MOULDING&MILLWORK FA0003555 LOCATION WITHIN SI I b(optional) 43 PHONE I.TANK DESCRIPTION(A sealed plot plan with m the Imation of the UST systeincluding bildi ungs and landmarks shall be submitted to[he local agency. Tr K IDN 432TANK MANUFACTURER 433 COMPARTMENTALIZED TANK El Yes ❑ 434 Tr If"Ya",ooaglat,ota mefor each. (� DATE INSTALLED(YEA O) 435TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 7 500 ADDITIONAL DESCRIPTION(Fa lo.l ase only) 21' j11 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ❑ 1.MOTOR VEHICLE FUEL ❑ 1.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (IfoarkW con,letc Petroleum Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ lc MIDGRADEUNLEADED ❑4.GASOHOL ® 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(bpm Haardoa Matenah Imemory Page) q41 CAS#(from Raardo.Matetiak Inventory page) 442 ❑4.HAZARDOUS WASTE (Inhales Uaed W) E195.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ L SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ S.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 413 (Check one it=only) EXTERIOR MEMBRANE LINER [195.UNKNOWN ❑ 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-tommly tank Ell.BARE STEEL ❑FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 ((2lick oM hem.*) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIRLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 (Checkoneftem.r1y) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1 RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED as7 OR COATING (Check one hem only) El ALKYD LINING El PHENOLIC LINING E:16 UNLINED [-1 99 OTHER (For I.d use only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED M9 PROTECTION IF APPLICABLE PROTECTION (Check one than only) ❑ 4 IMPRESSED CURRENT El 99 OTHER ❑ 2 SACRIFICIAL ANODE (For brat uac only) SPILL AND OVERFILL YEAR INSTALLED 451) TYPE(local uu only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ❑ 1 SPILL CONTAINMENT ❑ 1 ALARM ❑ 3 FILL TUBE SHUT OFF VALVE ❑ 2DROP TUBE ❑ 2BALL FLOAT ❑4EXEMPT ❑ 3 STRIKER PLATE IV.TANK LEAK DETECTION(A dcsaripnon of the monhonog program:hall be submined to the local agary.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check ore item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) [:13 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑ 2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING [:13 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 451 gallons ❑Yes ❑No UPCF(12/99 revised)