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UNIFIED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANKS -TANK PAGE 1 TANKS II fneo pages per lank) II TYPE OF ACTION D 1, NEW SITE PERMIT D 4. AMENDED PERMIT S. CH NGE OF INFORMATION)) / ❑ e. TEMPORARY SITE CLOSURE (Check one INm only) 6AM/'%'4e4q^L >< PERMANENTLY CLOSED ON SITE Aill 03. RENEWAL PERMIT rs...w.....,..�. s..hul u.. mbl (Saadi hangs-br localussonly) jjQ�F D B. TANK REMOVED 430 IINNrEES,S/NAME (Same NAME orDBA-Deng Busineaa ss))) FACILIN IDt S aas'FA�CIILID; Niljpinjo 6111 LOCATIONUIN SITE (Oplia.0 431 /a �'w NN91 k/, LJ! W y I. TANK DESCRIPTION TAyysM / I TANKMANUFACTURER� •. II 7Js G COMPARTMENTALIZED TANK ❑ Yea No If Yes', mmplaN one page fa esrll comparNrent. DATE INSTAL) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS J�� LTA ADDITIONAL DESCRIPTION (Farlooal use OnW U. TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ �2. LEADED D S JET FUEL 1. MOTOR VEHICLE FUEL (IfmaMeq oampleN Petrels -Type) te. REGULAR UNLEADED 01E PREMIUM UNLEADED ❑ 3. DIESEL D 8. AVIATION FUEL w D 2. NON -FUEL PETROLEUM D 1c MIDGRADEUNLEADED ❑ 4. GASOHOL I •99. OTHER D 3. CHEMICAL PRODUCT COMMON NAME (I.. Hezallous Merohala Invenlorypage) ;ASK(hem Hazallous Mahrriala lnvenrorypege) D 4. HAZARDOUS WASTE (lrnLdes "Am Op 13 95 III. TANK CONSTRUCTION TYPE OF TANK 1. SINGLEWALL D 3. SINGLE WALL NTH D 5. SINGLE WALL NTH INTERNAL BUDDER SYSTEM (Check oro dem Dory) ❑ 2. DOUBLEWALL EXTERIOR MEMBRANE LINER 095. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT 1199. OTHER TANK MATERIAL -pdmsry tank 1. BARE STEEL D 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 095. UNKNOWN (Chock mu ssm Dory) ❑ 2, STAINLESS STEEL ❑ 4, STEELCUDWIFIBERGIASS ❑ 8. FRP COMPATIBLE W1100% METHANOL ❑99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank 1 BARE STEEL ❑ 3. FIBERGLASSIPIASTIC ❑ B. FRP COMPATIBLE W1100% METHANOL ❑95. UNKNOWN (Check one dam ahoy) ❑ 2. STAINLESS STEEL ❑ 4. STEELCLADWIFIBERGUSS ❑ S. FRP NONUCORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC (FRP) [110, COATED STEEL D 5. CONCRETE TANK INTERIOR LINING 1RUBBER LINED ❑ 3. EPDXY LINING D 5, GLASS LINING D 95. UNKNOM433 DATE INSTALLED OR COATING �� UNLINED 099. OTHER ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING /-\. Forbcal use onl) Check one ttem and ) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN 434 DATEINSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT 099. OTHER (Forbcal use only) (Chock orN item only) ❑ 2. SACRIFICIAL ANODE SPILLAND OVERFILL YEAR INSTALLED TYPE(Forlonluseony) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED (Check aN that apply) D 1 SPILL CONTAINMENT ❑ 1. ALARM D 3. FILL TUBE SHUT OFF VALVE _ D 2. DROP TUBE ALA_ ❑ 2. BALL FLOAT X4. EXEMPT ❑ 3. STRIKER PLATE A" /� '.IV. TANK LEAK DETECTION> IF SINGLE WALL TANK(Chsck all that appy): IF DOUBLE WALL TANK OR TANK WITH BLADDER Chock ane dem only): ❑ 1, VISUAL(E)(POSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) D 1. VISUAL (SINGLE WALLIN VAULT ONLY) D 2. AUTOMATIC TANK GAUGING (ATG) D B. VADOSEZONE D 2. CONTINUOUS INTERSTITIAL MONITORING D 3. CONTINUOUS ATG D T. GROUNDWATER D 3. MANUAL MONITORING 04. STATISTICAL INVENTORY RECONCILIATION (SIR) 00. TANK TESTING BIENNIAL TANK TESTING � 99. OTHER�� r V. TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE UST USED (YRIMONAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED NTH INERT MATERIAL? g L_LL�L'� L ��pellona ❑yes No CUPAFORM (4/99) 0 Formerly SWRCB Form B