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01 -VMA 10-14-oz <br /> io i a2 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br /> (two pages per tank) <br /> �/ pm.-.f <br /> TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ffi 5 CHANGE OF INFORMATION C36 TEMPORARY SITE CLOSURE <br /> c <br /> (Chmcitwody) / ` ❑ 7 PERMANENTLY CLOSED ON SITE <br /> Cl 3 RENEWAL PERMIT (Spmfy.--f wmlmeoaly) '(Spemfy.-fmwminecoNy) ❑ 8 TANKREMOVED 430 <br /> BUSINESS NAME(Sweev FACa.ITYNAME or DBA-Dvivg Bu'vess Aa) FACIIdTY': I <br /> H 3 <br /> �1 Lj(a�;OR i GAS <br /> LOCATION WITHIN Sri E(opdo4d) - 431 <br /> E 5 c lo^ of %I T?- ' � ) FG AR e^ <br /> L TANK DESCRIPTION (A scaled plot plan with[ e location of'ihe UST system- cluding buildings and landmarks shall he submitted[o the total agency.) <br /> TANK ED �j g 0 n 17 4N TANK/MANUFACTURER 433 COMPARTMENTALIZED TANK Yes [I No 434 <br /> 1' ( <br /> U IJ. Xr L�� If.yu",mmPlnconeMcfmwc cmpMw <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY INGALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> MX99 9,000 <br /> ADDITIONAL DES ON(FartomLmewy) 438 <br /> IL TANK CONTENTS <br /> TANK USE 439 )LEUM TYPE 440 <br /> I. MOTOR VEHICLE FUEL '�l REGULAR UNLEADED ❑2:LEADED 05. JET FUEL <br /> (Ifmdad compm[a Peo-omum Type) Ib. PREMUM UNLEADED 03. DIESEL C1 6. AVIATION FUEL <br /> ❑2.NON-FUEL PETROLEUM Iv. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER <br /> ❑3. CHEMICAL PRODUCT COMMON NAME(fmm tmmrdoua Matcdols mvm4rypge) 40 CAS#(0ornllamdoua Memiala mveotary pgo) <br /> ❑4. HAZARDOUS WASTE <br /> (Ivcladm u..ed oa) g (�. r� <br /> 095.UNKNOWN GO 1) Ire � v`QNq <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK U 1. SINGLE WALL 3. SINGLE WALL WITH S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Ch=koneilwonly) EXTERIOR MEMBRANE LINER. ❑95. UNKNOWN <br /> DOUBLE WALL [14. SIGNLE WALL IN VAULT ❑99. OTHER <br /> TANKMATERIAL-priaurytmk 1. BARE STEEL off3, FIBERGLASS/PLASTIC Lj 5. CONCRETE U 95. UNKNOWN 444 <br /> (Chmkom Aanooly) Cl 2. STAINLESS STEEL [:14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W1100%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-smandazytmk I. BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN 445 <br /> (Ossrtvm itwawy) El2. STAINLESS STEEL STEEL CLAD W/FTBERGLASS [18. FRP COMPTIBLE W/100%METHANOL <br /> ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) ❑10.COATED STERL <br /> ❑5: CONCRETE <br /> TANK INTERIOR LINING 1.RUBBER LINED ❑3.EPDXY LINING 5.GLASS LINING 05.UNKNOWN W DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER <br /> (Check ode itwmty) (FwloW use only) <br /> OTHER CORROSION V MANUFACTURBO CATHODIC�3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN DATE INSTALLED 449 <br /> PROTECTION IF APPLIC LE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER <br /> (Chink mcitwadY). ❑2 SACRIFICIAL ANODE (Far loml ax awy) <br /> SPILL AND OVERFILL YEARINSTALLED 4M TYPE(lomlux my) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 453 <br /> (@akall Not 4PPIY) SPILL CONTAINMENT I ALARM FIS TUBE SHUT OFF VALVE <br /> X DROP TUBE BALL FLOAT ❑4 EXEMPT <br /> ❑3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(A dm pdm afweemmiwrmg Pmg;w nesubmitW wine win[4gmay.) <br /> IF SINGLE WALL TANK(( 4i dut. y) - 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(hrrG) (]I VISUAL SINGLE WALL IN VAULT ONLY) _ <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE /W CONTINUOUS INTERSTITIAL MONITORING <br /> 113 CONTINUOUS ATG - ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4STATISTICAL INVENTORY RECONCILIATION ❑8TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTBER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> N jfa� ❑Yes ❑ No <br /> UPCF(12/99 revised) 10 Formerly SWRCB Form B <br />