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ff 960 <br /> UN I FIED P ROGRAM CONSOLIDATED FORM i / TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1s� <br /> I (%ho pages per tank) <br /> Pepe _ of _ <br /> ❑ 6.TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION 01.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION) ❑ T PERMANENTLYCLOSED ON SITE <br /> (Check one item omy) <br /> ❑3.RENEWAL PERMIT (5peply.-the, lorbcel uas only) (SpecAy chonpa-brbuluas ony) ❑ 6.TANK REMOVED 430 <br /> 1 <br /> BUSINESS NAME(Same as FACIUtt NAME or DBA-Doing Buainesa Aa) <br /> �� FACILITY IDt <br /> U&t 44 <br /> LOCATION WITHIN SITE(Oporonep 431 <br /> 1.TANK DESCRIPTION <br /> TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yea ❑ No <br /> TANK�O�ff& ^ / ^ D If-Yes,complete one page for each comparMent. <br /> !/11 TANK CAPACITY IN GA11 " SJ` NUMBER OF COMPARTMENTS <br /> DATE INSTALLED(YEARRAO) D�DDD <br /> /0 93 <br /> ADDITIONAL D RIPTION tForbcal uss only) <br /> II.TANK CONTENTS <br /> TANK USE 432 �,../ PETROLEUM TYPE ❑ 5. JET FUEL <br /> �1a, REGULAR UNLEADED ❑ 2. LEADED <br /> 1. MOTOR VEHICLE FUEL A _ ❑ 3. DIESEL ❑ 6. AVIATIONFUEL <br /> (h ryeQCompfaN Paholwm Type) ❑It. PREMIUMUNLEADED ❑99. OTHER <br /> ❑ 2. NON-FUEL PETROLEUM ❑Ic MIDGRADE UNLEADED ❑ 4. GASOHOL <br /> ❑ 3CAS%(Nom Hazardous Maferiafs lnvenforypepe) <br /> . CHEMICALPRODUCT <br /> COMMON NAME(ham Hazardous Materials Invenrorypape) <br /> ❑ 4. HAZARDOUS WASTE(Includes <br /> Load Oip <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ t. SINGLE WALL ❑ 3. SINGL ERIORM WITHMBRA <br /> ❑ S. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> {,..,� EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> (Check one item 0hWJ pt2. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER <br /> TANK MATERIAL-primary lank ❑ 1 BARE STEEL <br /> ❑ FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> (ChacNonedemanry) 1:1 2. STAINLESS STEEL SEINFORAD WIFIBERGIASS ❑ 6. FRP COMPATIBLE WI100%METHANOL ❑99. OTHER <br /> REINFORCED PLASmC(FRP) <br /> TANK MATERIAL-secondery lank ❑ 1. DARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 6. FRPCOMPATIBLEWl1W%METHANOL ❑95. UNKNOWN <br /> (ChackonettemonM ❑ 2. STAINLESS STEEL � STEEL CLAD WIFISERGLASS ❑ 9. FRP NON-CORRODMUE JACKET El 99. OTHER <br /> REINFORCED PLASTIC(FRP) [110, COATED STEEL <br /> ❑ S. CONCRETE <br /> DATE INSTALLED <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 <br /> OR COATING ❑ 4. PHENOLIC LINING UNLINED ❑99. OTHER Fwlwalusaonl) <br /> ❑ 2. ALKYD LINING DATEINSTALLED <br /> (Check pm fim ohi) <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 <br /> PROTECTION IF APPUCABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Forloceluasonly) <br /> (Check ons loam eery) ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocaluseonty) <br /> (Checkalflhet APPW ❑ 1 SPILL CONTAINMENT ❑ 1.ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROPTUSE y9 ❑ 2. BALL FLOAT_ ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> 'N'. TANK LEAK DETECTION <br /> IF DOUBLE WALL TANKORTANK WITH BLADDER(Check one item onl): <br /> LEWALL TANK CMCN ap mat ep ): ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> ❑ 1, VISSUALUALtE%POSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) <br /> ❑ B. VADOSE20NE . CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 3. MANUALMONITORING <br /> ❑ 3. CONTINUOUS ATG. [1T. GROUNDWATER <br /> ❑ 4. STATISTICALINVERTORYRECONCILIATION(SIR) ❑ 6. TANKTESTING <br /> BIENNIAL TANK TESTING N. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> 435 TANK FILLED`WITH INERT MATERIAL? <br /> ESTIMATED DATE usf USED(PRIMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING _ <br /> galone - ❑yea ❑No <br /> • . Forrnedy SWRCB Form B <br /> CUPAFORM(4199) <br />