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0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 �1003 <br /> (Mro pages per lank) <br /> Page _ of _ <br /> WPEOFACTION 01.NEW SITE PERMIT 0 4.AMENDED PERMIT ❑ S.CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE <br /> (Chock oris item onl)) ]. PERMANENTLY CLOSED ON SITE <br /> 03.RENEWAL PERMIT (Spedly,Mason-7urkcel we only) (SpeclychaMe-brbulussonly) S.TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Dake Businsas As) FACILITY 10 # t <br /> 3501 <br /> LOCATION WITHIN SITE Optianep 1 �A /131 <br /> \1 ICN C <br /> aA Cy <br /> I.TANK DESCRIPTION <br /> TANK TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes ❑ No <br /> l v/ _ It'Yei,complete one page far Bate compartment <br /> GATE INSTALLED(YEARIMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> ADDITIONAL DESCRIPTION(Forlocal...nly) <br /> ILTANKCONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ❑ <br /> I.MOTOR VEHICLE FUEL ❑le REGULARUNLEADED ❑ 2. LEADED ❑ 5. JETFUEL <br /> (I/marksd,complete Panels-Type) 0m. PREMIUM.UNLEADED ❑ 3.DIESEL 0 B. AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM 01. MIDGRADE UNLEADED ❑ 4.GASOHOL 1199. OTHER <br /> 0 3. CHEMICAL PRODUCT COMMON NAME(from Hazanlws Mafs"s bwntoryPape) <br /> CAS%(4om Mazanlous <br /> 0 4. HAZARDOUS WASTE llnfu . Materials lnvenforypape) <br /> Used Oip <br /> In 95 UNKNQffl <br /> IN.TANK CONSTRUCTION <br /> TYPE OF TANK 01 SINGLE WALL ❑ 3.SINGLEWALLWITH ❑ 5. SINGLE WALL WITH INTERNAL BLAODER SYSTEM <br /> (Check one item only) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> ❑ 4. SINGLE WALL IN A VAULT 09g OTHER <br /> TANK MATERIAL-primary lank 0 1. BARESTEEL ❑ 3. FIBERGLASSIPIASTIC 0 5.CONCRETE 095. UNKNOWN <br /> (CMckorrodemonty) ❑ 2. STAINLESS STEEL 0 4. STEEL CIADWIFISERGI.ASS ❑ S. FRP COMPATIBLE W/100%METHANOL 1199. OTHER <br /> REINFORCED PLASTIC FR <br /> TANK MATERIAL-seconeary tank 0 1 BARE STEEL ❑ 3. FISERGIASS/PLASTIC 0 S.FRP COMPATIBLE WI100%METHANOL El 95. UNKNOWN <br /> (Check oheilamoMy) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ S. FRP NON-CORRODIBLE JACKET _ ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) 010. COATED STEEL <br /> ❑ S.CONCRETE <br /> TANK INTERIOR LINING 0 1. RUBBER UNED ❑ 3. EPDXY LINING ❑ S.GLASSUNING 095. UNKNOWN433 DATEINSTALLED <br /> ORCOATING <br /> ❑ 2.ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 8. UNLINED ❑99. OTHER Forlaaal use <br /> Check one item omr) <br /> OTHER CORROSION 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑85. UNKNOWN 436 DATEINSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT 099.OTHER <br /> (Check one Item Doty) ❑ 2. SACRIFICIALANODE (FWlacal use only) <br /> SPILL AND OVERFILL YEARINSTALLED TYPE(Forbcalusa only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> ICheolr am lhat apply) 0 1. SPILL CONTAINMENT ❑ 1. ALARM 0 3. FILL TUBE SHUT OFF VALVE <br /> 0 2. DROPTUBE ❑ 2. BALL FLOAT ❑ 4.EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> rV.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK Check as that a ): IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item onl): <br /> 0 1, VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTD) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) 0 B. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ' <br /> ❑ 3. CONTINUOUSATG. ❑ 7. GROUNDWATER ❑ 3. MANUALMONITORING <br /> 0 4. STATISTICAL INVENTORY RECONCILIATION(SIR) 0 B. TANKTESTING <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LASf USED(YRIMMDAY) - ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLEO WITH INERT MATERIAL] <br /> /L 0 3 - galore ❑Yes 0 No <br /> CUPAFORM(4199) Fomredy SWRCB Form B <br />