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�P`"1� 6 Slv� QcJlz UNIFIED PROGRAM (UP) FORM ZtIf4 )D`t 1 UNDERGROUND STORAGE TANKS -TANK PAGE 1 two a es rtank Pa a of TYPE OF ACTION 01.NEW SITE PERMIT 03.RENEWAL PERMIT 0 5.CHANGE OF INFORMATION 0?.PERMANENTLY CLOSED SITE (Check one Rem only)only) O 2.INTERIM PERMIT 4.AMENDED PERMIT O&TEMPORARY SITE CLOSURE 0 8.TANK REMOVED 430 BUSINESS NAME(Sam as FACILITY NAME or DBA) FACILITY ID: 1 3 Tesoro West Coast Company,LLC USA,CC#68222 LOCATION WITHIN SITE(optionaq 431 I. TANK DESCRIPTION A scaled plot plan with location(s) of UST system(s)including buildings and landmarks shall be submitted to the COPA or PA. TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes No 434 MODERN WELDING e'Yes',complete one page for each compartment. DATE INSTALLED(YEA O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 UKN 1 12,000 ADDITIONAL DESCRIPTION(For local use only) 436 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ®la. REGULAR UNLEADED 0 2. LEADED 0 5. JET FUEL (a marked complete Petroleum Type) 01b. PREMIUM UNLEADED 03. DIESEL O6. AVIATION FUEL O 2. NON-FUEL PETROLEUM O 1c. MOGRADE UNLEADED 0 4. GASOHOL 0 99.OTHER: 0 3. CHEMICAL PRODUCT COMMON NAME 441 CAS# 442 (from Hazardous Materials Inventory page) (from Hazardous Materials Inventory page) 0 4. HAZARDOUS WASTE(Includes Usee Oil) 0 95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK 0 1. SINGLE WALL 0 3. SINGLE WALL WITH U 5. SINGLE WALL WITH INTERNAL BLADDER ((Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 443 0 2. DOUBLE WALL 04. SIGNLE WALL IN VAULT 0 99. OTHER TANK MATERIAL-primary tank C9 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN ((Check we item only) 0 2. STAINLESS STEEL 0 4. STEEL CLAD W/FIBERGLASS O 8. FRP COMPTIBLE W/100%METHANOL O 99.OTHER 444 REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank 1. BARE STEEL 03. FIBERGLASS/PLASTIC 05. CONCRETE 0 95. UNKNOWN ((Check ane item only) 0 2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 08. FRP COMPTIBLE W/100%METHANOL 0 99.OTHER 445 REINFORCED PLASTIC(FRP) 0 10.COATED STEEL TANK INTERIOR LINING 0 1.RUBBER LINED 0 3.EPDXY LINING 0 5.GLASS LINING 0 95.UNKNOWN DATE INSTALLED 447 OR COATING 0 2 ALKYD LINING 0 4 PHENOLIC LINING 0 6 UNLINED 0 99 OTHER 446 (For local use only) (Check one item only) OTHER CORROSION 0 1 MANUFACTURED CATHODIC 0 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN DATE INSTALLED 446 PROTECTION(IF APPLICABLE) PROTECTION 0 4 IMPRESSED CURRENT 0 99 OTHER 448 For local use only) Check one item only) 0 2 SACRIFICIAL ANODE SPILL AND OVERFILL (Check all that apply) YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 0 1 SPILL CONTAINMENT ®1 ALARM 0 2 DROP TUBE ®2 BALL FLO AT 0 3 STRIKER PLATE ❑3 FILL TUBE SHUT OFF VALVE O 4 EXEMPT IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) O 1 VISUAL(EXPOSED PORTION ONLY) 0 5 MANUAL TANK GAUGING(VTG) 0 1 VISUAL(SINGLE WALL IN VAULT ONLY) O 2 AUTOMATIC TANK GAUGING(ATG) 0 6 VADOSE ZONE CRI 2 CONTINUOUS INTERSTITIAL MONITORING 0 3 CONTINUOUS ATG 0 7 GROUNDWATER 0 3 MANUAL MONITORING 0 4 STATISTICAL INVENTORY RECONCILIATION 0 8 TANK TESTING (SIR) t BIENNIAL TANK TESTING 0 99 OTHER V. TANK CLOSURE INFORMATION If PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRIMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 TANK FILLED WITH INERT MATERIAL? 657 O Yes ONO OFFICIAL USE ONLY DATE RECEIVED CUPA PA DISTRICT/INSPECTOR UP FORM(1/2000 Version) 1 Formerly SWRCB Form B SBC UST-B.doc