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D PROGRAM CONSOLIDATED FO TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 1-pages per tank) Page1 ,uf/P TYPE OF ACTION ❑t NEW SITE PERMIT ❑ 4 AMENDED PERMIT xi 5 CHANGE OF INFORMATION 136 TEMPORARY SITE CLOSURE T L (CNet me item mly) ❑ 7 PERMANENTLY CLOSED ON SITE I ❑ 3 RENEWAL PERMIT (SperiHteeeea-fmlamlu.emly) (srcdH mom-Imlml ue mlY) ❑ 8 TANKREMOVED 430 1I I SY B�US"I"NESS NAMHpm (ge me FACILITY NAMam DBA-Daleg Dmim.Aa) FACILITY ID: I 7 .�4rL tTOQ AAt JoOA Tran61 1715 d 3 LOCATION WITHIN SITE(o eh o L TANK DESCRIPTION (A soled plot plan with the location of the UST system including buildings and landmarks shell be submitted to the taint agmryJ T IDM u1 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes o .11 �b � -T o11U'816 GWens Corni If•Yea^,omnpmeuuepegefore.cncompemneut DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 5 to q2 I 2ojxo qd11v,,5 NA ADDITIONAL DESCRIPTION(Fmmen.mll) 439 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE Ono L MOTOR VEHICLE FUEL ❑Ia, REGULAR UNLEADEDLEADED [35. JET FUEL (Ifmrteaconm4m Peholem Type) ❑Ib. PREMIUM UNLEADED 3. DIESEL ❑6. AVIATION FUEL [12. NON-FUEL PETROLEUM ❑1.. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (Ome N.mam.Mtleirak Ie eesmy page) 441 CASH(eemm R.naroua M.t,ome Invmbrr page) 441 ❑4. HAZARDOUS WASTE (arelu ueeNOi9 DiaSeL Fwt CAS :}684-76- 34--6 ❑95.UNKNOWN ID. TANK CONSTRUCTION TYPE OF TANK El L SINGLE WALL Ll 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM nu (c eemekmomy) EXTERIOR MEMBRANE LINER 095.UNKNOWN JN 2. DOUBLE WALL [14. SIGNLE WALL IN VAULT ❑99.OTHER TANKMATERIAL-peimaptsot Lj 1. BARESTEEL 3. FIBERGLASS/PLASTIC LJ 5. CONCRETE L1 95.UNKNOWN 444 (Ouaooe km only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANKMATERIAL-ecmmeytaa 0 L BARESTEEL pq 3. FIBERGLASS/PLASTIC 0 5. CONCRETE El 95.UNKNOWN 445 (Chea me itm oNy) ❑2. STAINLESS STEEL E34. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/IOU%WTHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING El 1.RUBBER LINED ❑3.EPDXY LINING 5.GLASS LINING 0 95.UNKNOWN 446 DATE INSTALLED 07 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (CLeet oee am eay) (Forlmal use eNy) OTHER CORROSION ❑1 MANUFACTURED CATHODIC 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN ' DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (ceeameixm mH) ❑2 SACRIFICIAL ANODE (Fm lmel ose mfr) SPILT.AND OVERFILL YEAR INSTALLED ISD TYPE(beat me mly) 451 OVERFILL PROTECTION EQUIPMEIT :YEAR INSTALLED�.j fP 451 (C3ectall slut apply) I SPILL CONTAINMENT C1 ALARM P 3 FILL TUBE SHUT OFF VALVE NJ 2 DROP TUBE ❑2 BALL FLOAT ❑4 EXEMPT 3 STRIKER PLATE IV.TANK LEAK DETECTION(A NesCTPtion ofine momtmire program stun to sumnikea m the mml agency) IF SINGLE WALL TANK(ceea.0 le.t.ppy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ((.Lent me km mly) ❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑I VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK CA GOING(ATG) ❑6 VADOSE ZONE 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4STATIS77CALINVENTORY RECONCILIATION ❑8TANK TESTING (SIR) BIENNIAL..TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING ub 7ANKFHLED WITH INERT MATERIAL? ss7 gallons ❑Yes ❑ No UPCF(12/99 revised) 10 Formerly SWRCB Form B