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WFIED PROGRAM CONSOLIDATED F* TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (Two pages per tank) Page 1 of 2 TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify meson) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(Same as FACILITY NAb]Bor DBA-Doing Business As) 3. FACILITY ID: I. ARCO Facility No.9600 LOCATION WITHIN SITE(Ornament 471. I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall besubmittedto the local agency.) TANK ID N 432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK ❑Yes ® No 434. 2 Modern Welding W'Yes,"compleleonepegefbreechcompemment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437. (YEAR/MO) 04/15/95 12093 0 ADDITIONAL DESCRIPTION(For local we only) 438. H.TANK CONTENTS TANK USE 439. PETROLEUM TYPE 440. ® 1. MOTOR VEHICLE FUEL N la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If checked,complete Petmleum Type) ❑lb. PREMIUM UNLEADED 03. DIESEL 06. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑In. MD)GRADE UNLEADED [14. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (fmm Hma dow Materiels(memory page) 441. CAS4(f om Hazardom Materiels Inventory page) 442 ❑ 4. HAZARDOUS WASTE Gasoline 8006-61-9 (Incmd®Ueed Oil) ❑ 95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑I. SINGLE WALL [13. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INFERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER [195, UNKNOWN ®2. DOUBLE WALL [14. SINGLE WALL IN A VAULT [199. OTHER TANK MATERIAL-primary tank LI 1. BARE STEEL Ll 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one dem only) ❑2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC W/100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC LIS. FRP COMPTIBLE W/100%METHANOL [195,UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL ®4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET [199.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED [13.EPDXY LINING [15.GLASS LINING [195,UNKNOWN 446. DATE INSTALLED 447, OR COATING ❑2.ALKYD LINING [14.PHENOLIC LINING ®6.UNLINED ❑99.OTHER Check one item only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC ®3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.UAPRESSED CURRENT ❑99.OTHER f Applicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) O L SPIN,CONTAINMENT 1995 ❑1.ALARM unk 03.FI.L TUBE SHUT OFF VALVE ®2.DROP TUBE 1995 ®2.BALL FLOAT unk. ❑4.EXEMPT ®3.STRIKER PLATE 1995 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 that apply) (Check one item only) ❑1.VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG ❑7.GROUNDWATER [13.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION [18.TANK TESTING (SIR)+BIENNIAL TANK TESTING [199.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 WIT]I INi:R,r MATERIN2 457. N A gallons ❑Ycs ❑ No (� Rev.02/16/00 UPCF hwfwrc-b(1/99)-2/4 http://www.unidocs.org /_�I