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�� 0 -7 faint � O IFIED PROGRAM CONSOLIDATED FORFI TANKS \fib UNDERGROUND STORAGE TANKS - TANK PAGE 1 �1 (Two pages per tank) Page_of_ TYPE OF ACTION ® 1.NEW PERMIT ❑ 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item ordy) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reesoa) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(S.as FACILITY NAME m DBA-Wing lhimss As) 3. FACILITY ID: I. Great American Gas&Car Wash /��1 q LOCATION WITHIN SITE(optiow) -7-Pro Sr 431. 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 p 432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK Yes No 434. 2A Containment Solutions If"Yes,"complete one page for each compammem DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 (YEAR/MO) 2006/9 12,000 2 ADDITIONAL DESCRIPTION(Fm local ux only) 438. IL TANK CONTENTS TANK USE 439. PETROLEUM TYPE 440. ® I. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Ifcheckd,complain Pevoleum Type) ®lb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDCRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from naardous Material.Inventory page) 441 CASN(from Haaminus Materials lnvemory page) 443_ ❑ 4. HAZARDOUS WASTE Oncludm UW oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK 0 1. SINGLE WALL [33. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN ®2. DOUBLE WALL [14, SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tank ❑1. BARE STEEL 3. FIBERGLASS/PLASTIC El 5. CONCBETE 0 95.UNKNOWN as4. (Check one item only) [12, STAINLESS STEEL [14, STEEL CLAD W/FIBERGLASS 08. FRP COMPATIBLE ❑99.OTHER: REINFORCEDPLASTIC FRP W/100%METHANOL TANK MATERIA.-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ®8. 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 ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑S. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING 0 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ®6.UNLINED ❑99.OTHER Check one item only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC ®3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DATE INSTALLED aae. PROTECTION PROTECTION [14.IMPRESSED CURRENT ❑99.OTHER If licable ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEARINSTALLED 450, TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) ®1.SPILL CONTAINMENT 2006 ®1.ALARM 2006 ❑3.FILL TUBE SHUT OFF VALVE ®2.DROP TUBE 2006 ®2.BALL FLOAT 2006 ❑4.EXEMPT ®3.STRIKER PLATE 2006 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 45a (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 ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑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 gallons ❑Yes ❑ No PPCF hwfwrc-b(1/99)-1/4 http://www.unid"s.org Rev.02/16/00