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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS-TANK <br /> 7PAGE 1 TANKS <br /> va9e _ <br /> TYPE OFe see, ❑1,NEW SITE PERMIT Cl !. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE <br /> (Uack om il.m wYn � - <br /> ❑J.RENEWALPERMIT (Spsulynason IwbcN use ?. PERMANENTLY CLOSED ON SITE ✓/` <br /> oMY) (SPIK's,"upe-Iwbcp vas wM9 ❑ B. TANK REMOVED 430 <br /> BUSANE55 NAME(SameCCaa FFGLIIY NAME wDBA-Da*IY Buswe>A» FACILITY 101 <br /> LOCATI CSITE(VINsweeso 431 <br /> TANK ID I_ TANK MANUFACTURER 1.TANK DESCRIPTION <br /> A } /6/� COMPARTMENTALIZED TANK ❑ Yes ❑ Ne <br /> DS/ <br /> n J it'YQs.complete one Psos Iw ear r mpaNnent <br /> GATE INSTALLED(YEAR/MO) TANK CAPACITY IN WLLONS NUMB[0.0f COMPARTMENTS <br /> ADDITIONAL DESCRIPTION(Fwkmal we ory-J <br /> 11.TANK CONTENTS <br /> tt�� TANK USE t22 PETROLEUM TYPE <br /> LJ-p, MOTOR VEHICLE FUEL ❑L. REGULAR UNLEADED D 2. LEADED ❑ 5. JET FUEL <br /> I(Ipl(maheE'cwrplala PelmNwn Type) ❑IO. PREMIUM UNLEADED Cd 2. NON-FUEL PETROLEUM ❑ 3. DIESEL ❑ 6.AVIATION FUEL <br /> A D 1c, MIGGRADE UNLEADED ❑ t,GASOHOL ❑99. OTHER <br /> D 3. CHEMICAL PRODUCT <br /> D t. HAZARDOUS WASTE(ImAxJes COMMON NAME R.NaaNHova MaIwals InWrgorypa9eJ CAS•prom NauNnus McPolals Invemorypage) <br /> Us"00) <br /> V III.TANK CONSTRUCTION (,l•�''ly <br /> TYPE OF TANK 1, SINGLE WALL ❑ 3. SINGLE WALL WITH D S SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Cees*one item orgy) D 2. DOUBLE WALL EXTERIOR MEMBRANE LINER D95, UNKNOWN <br /> ❑ t. SINGLE WALL IN A VAULT <br /> �/ ❑99. OTHER <br /> TANK MATERIAL.primary MM D 1 BARE STEEL D 3, FISERGLASSIPLASTIC Dp 5.CONCRETE <br /> LLJ.� 1195. OTHERUNKNOWN <br /> (CeK.......y) ❑ 2 STAINLESS STEEL ❑ t. STEEL CL PLASTflGLA55 6 FRP COMPATIBLE W/100%METHANOL 13 99. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-leowBary UIM D 1 BARE STEEL D 3. FIBERGLASSIP(ASTR: D a. FRP COMPATIBLE W/107%METHANOL 0 9. UNKNOWN <br /> (Checkom dsm orgl'I ❑ 2. STAINLESS STEEL D t. STEEL CLAD MFIBERGLASS 09. FRP NONCORROOIBLE JACKET 1199. OTHER <br /> REINFORCED PLASTIC(FRP) 1110, COATED STEEL <br /> D S. CONCRETE <br /> TANK INTERIOR LINING <br /> CWTRI D D D 1. RUBBER UNED 3. EPDXY LINING 5. GLASS LINING ❑95. UNKNOWN433 DATE INSTALLED <br /> TA <br /> (Checkonelemo ) D 2. ALKYD LINING D t. PHENOLIC LINING UNLINED ❑99. OTHER <br /> OTHER wkcal vae ) <br /> PROTECTION <br /> IF ON D 1. MANUFACTURED CATHODIC G 3. FIBERGLASS REINFORCED PLASTIC 1395, UNKNOWN Ot DATEINSTALLEO <br /> PROTECTION IF APPLICABLE <br /> PROTECTION ❑ t. IMPRESSED CURRENT 1399.OTHER <br /> (Check we tem No D 2 SACRIFICIAL ANCOE (Fwbca/uae o^N) <br /> SPILL ANDapptERFLL YEAR INSTALLED TYPE(FPrbcal use orgy) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check aY feel al app0? 1 SPILL CONTAINMENT <br /> ❑ L ALARM ❑ 3 FILL TUBE SHUT OFF VALVE_ <br /> ❑ 3. DROP L Cl 2. BALLFLOAT ❑ t. EXEMPT <br /> ❑ ]. STRIKERIKER PLATE <br /> -A <br /> W.'TANK LEAK DETECTION <br /> IF SINGLE WALL TANKCsekea lhalap )r IF DOUBLE WALL TANK OR TgNK WITN BLADDER *one ifemw <br /> ❑ 1, <br /> VISUAL(EXPOSED PORTION ONLY) D S. MANUAL TANK GAUGING(MTG) D I. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> 2. AUTOMATIC TANK GAUGING(ATG) I ❑ 0. VA(K)SLZONL ❑ 2 CU(IINUUUSINIENS BI IALMUNITURING <br /> Cl 3. CONTINUOUSATG ❑ T. GROUNDWATER D 3. MANUALMONITORING <br /> ❑ t. STATISTICAL INVENTORY RECONCILIATION(SIR)e D B. TANK TESTING <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V,TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED BATE LAST LASED(YR/MOIpAY) ESTIMATED OUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> 9aeons <br /> ❑Yes ❑No <br /> Ile 11 <br /> CUPAFORM(1/99) <br /> Formerly SWRCB Fonn B <br />