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'UNIFIE <br /> D PROGRAM CONSOLIDATED FO <br /> UNDERGROUND STORAGE TANKS- TANK PAGE 1 TANKS <br /> (two Pages Per tank) O� <br /> 'TYPE OF ACTION ❑INEW SDE PERMIT EI4 AMENDED PERMIT X SCHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE naeof -3 <br /> (Ctect one In.mTy) ❑ 7 PERMANENTLY CLOSED ON SITE '1 <br /> ❑ 3 RENEWAL PERMIT (Spe iry�eavm-fm lm.l ice mlY) (s1a•'ity rt+wn-fm 1001 ice ml <br /> Smea PWILITY NAMEo DBA- y) ❑ R TANK REMOVED <br /> BUSINESS NAME a3a <br /> ( Dews Best.A.> FA©CITY ID: 1 <br /> Sanibagvin Ke5;0WLTraTlsli-DistriEt 3 <br /> LOCATION WITHIN SITE(opi) <br /> UI <br /> I.TANK DESCRIPTION (A scalodplot plan with the loralion of the UST system Including buildings and landma>ty shall be snb=md to the local agenry.) <br /> TANK ID N 43T TANK MANUFACTURER 435 COMPARTMENTALIZED TANK U Yes No Uo <br /> TA01158�y Owens Corn It'Ya'.cunpgemepage fineaehmmpmmam. <br /> '^ ` DATENI n2YEAR/MO) - TANK CA 91 GALI,TO�NS - NUMBER OF COMPAI,RtT NTS 497 <br /> ADDTTIONALDIESC ZION(Forlm.i..i,) ((�' I V rt <br /> ass <br /> IL TANK CONTENTS <br /> TANK USE 4I9 PETROLEUM TYPE <br /> ❑L MOTOR VEHICLE FUEL ❑le. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL 4m <br /> (Itmrtte4omtplee Pehnkum TYK) <br /> 11 Is- PREMIUM UNLEADED 03. DIESEL <br /> ❑ FUEL <br /> Z NON-FUEL PETROLEUM ❑6.AVIATION <br /> ❑Ic. MIIXiRADEUNLEADED 04. GASOHOL W99-OTHER UseSe <br /> d OIL <br /> ❑3. CHEMICAL PRODUCT COMMONNAOtf ME (MmN.nNou.M.Mia4 lanemm p,3 401 CASk(nom Rana m.Malviale lovemory page) 4a2 <br /> Ipf4. HAZARDOUS WASTE USea � <br /> 0wiu4 IJaena0 C A 5 #18002- 05-09 <br /> ❑95.UNKNOWN <br /> IH. TANK CONSrRUCTTON <br /> TYPE OF TANK 0 1. SINGLE WALL 3. SINGLE WALL W17H 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 4p <br /> (Oecdoevba Uy) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> 02. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑W. OTHER <br /> TANK MATERIAL-pimry apk 1. BARE STEEL J. FBERGLASS/PLASTIC 5. CONCRETE 95.rINKNOWN zw <br /> (LTe Y one Bmi oNY) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/F(BERGLASS ❑8. FRP COMPIIBLE W/10W.METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-aaea ,y-4 U L BARE STEEL od 3. FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 445 <br /> (clod,one nem MY) 02. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 08. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) ❑10.COATED STEEL <br /> ❑5. CONCRETE <br /> TANK INTERIOR LINING 01.RUBBER LINED 3.EPDXY LINING 5.G[,ASS LDNIN(i 95.UNKNOWN aa6 DATE INSTALLFD 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER <br /> (CheA one ilmt only) <br /> (Fmbc.l oae ody) <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC W3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 4U DATE INSTALLED 4N <br /> PROTECTION IF APPLICABLE PROTECT70N ❑4IMPRESSED CURRENT ❑99 OTHER <br /> (CMetmeiaan mlY) ❑2 SACRIFICIAL ANODE <br /> (Pmimvl uae mly) <br /> SPILL AND OVERFILL YEARINSTALLED 450 TYPEgaaw wmly) UI OVERFILL PROTECTION EQUIPMENTMEAR INSTALLED U2 <br /> (CTeettllaMwly) 1 SPILL CONTAINMENT 0 ALARA( ❑3 FILL TUBE SHUT OFF VALVE <br /> ❑2 DROP TUBE ❑2 BALL FLOAT 4 EXEMPT <br /> ®3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(A aacaipim orate M suammea to the lonl.geoey.) <br /> IF SINGLE WALL TANK(ctent.n aura apply) 4D IF DOUBLE WALL TANK OR TANK WITH BLADDER 414 <br /> (Cuda one nem cegy) <br /> ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE 2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUALMONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑R TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> TV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MG/DAY) ls5 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED wmi INERT MATERIAL? 457 <br /> gallons ❑Yes ❑ No <br /> UPCF(12/99 revised) l0 Formerly SWRCB Form 0 <br />