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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 Q <br /> (Nro p es perhnk) <br /> Page _ of _ <br /> TYPEOFACTION 01. NEYJSITEPERMG 0 4.AMENDEOPERUIT ❑ S. CHANGEOFINFORMATION) ❑ S.TEMPORARYSITECLOSURE <br /> (CneFk Me Xem aNy) ,❑,/T/PERMANENTLY CLOSED ON SITE <br /> ❑]. RENE\•JAL PERMIT (Speoy/eason•.Ybn/vse Mhl (Specey cnan,,k wbpJvuroJg IAT E.oTANK REMOVED <br /> IN'SS NAME ISame .FACILITY w A-Do'r59uslr<ssN) ] FACIIJtt IDR: 1 <br /> LOCATION WITHIN SITE(OP60n49. vt <br /> L TANK DESCRIPTION I-rvNA%atFkn.3:osematrn e/tne UST syaem Lwlcdq.Cuibilgs arYfanGna'.ls ahaD oe su-`.CNmme local agerryJ <br /> TANK ICF 4]2I TAN - 'NR`R 4V I..COMPARTMENTALIZED TANK 11 Y. 0No d]d <br /> B Yei,mmple:a One page fw Fatl16-mOamIIML <br /> OATE INSTALL` YEAPAJO) an TANK APA�ITY IN GALLONS 4b ' NULABER a COMPARTMENTS 4]. <br /> uf{k 12( 000 <br /> ADDITIONAL'L -SCRIPTION(Fel� ,;a M,l <br /> fl.TANK CONTENTS <br /> TANKUSE 439 �,/ PETROLE'SJ T, E 4ti <br /> i1p 1. MOTOR VEHICLE FUEL D la. R2GULURUNL F-o ❑ 2. LEAOEO ❑ 5. JET FUEL <br /> n'maneo.o,myete fktNr m TyFe) ip. PREMNAIUHLEA!ED 0 ]. DIESEL ❑6. AVIATIONFUEL <br /> ❑ 2. NON-FUEL VETROIEUM <br /> 11 1c MIDGRADE UNIvzzO ❑ a. GASOHOL 0N. OTHER <br /> 0 ]. CHCMICALPRODUCT <br /> COMMON NAME them 6'a:snxus Mafe^a'.Imen:wyPa9e) 4L1 I CAS!((rom HaxacbLrs Ka.'enas lmentorypag<) da <br /> ❑4. HAZARDOUS WASTE Rcdv.'n <br /> I.h Orp � I SAL oob �2q G�7 <br /> - <br /> lit.TANK CONSTRUCTION <br /> TYPE OF TANK 0 11_ SINGLE WALL 11 ]. SINGLE WQL WTTH ❑ 5. SINGLE WALL WITH I�ERNAL SADDER SYSTEM W <br /> !^✓¢rk Ere 4em only) 111 DOUBLE WALL EXTERIOR MEMi W1E LINER 1195 UNI<NOY•N <br /> 04. SINGLE WALL IN AVAULT 0g9 OTHER <br /> TMKMATERIAL-Fina•YLa^A 0 I. BARE STEEL ]. FIBERGLASS/PLASTIC 0 5. CONCRETE 095. UNKNOWN 4- <br /> (C koce rtem aMJ9 02. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS ❑ 6. FRP COMPATIBLE W1IW4 METHANOL 099. OTHER <br /> REINFORCED PLASTIC FRP <br /> TANK MATERIAL-se 2n lank❑ 1 BARE STEEL 0 3. FIBERGLASS/PLASTIC ❑8. FRP COMPATIBLE WIIWA METHANOL 95. UNKVOWN y <br /> (Cocci ace tem oNy) ❑ 2. STAINLESS STEEL 0 4. STEEL CLAD WITISERGLASS 0 9. FRP NON-CORROOIBLE JACIC.T 099. OTHER <br /> REINFORCED PLASTK:(FRP) 010 COATED STEEL <br /> 0 5. CONCRETE <br /> TANK UfTERIOR LINING 0 I RUS3ER LINED 0 3 EPOKYLINING 0 5 GLASS LINING 095. UNKNOWN ddb DATE INSTALLED �' <br /> OR COATING <br /> 13 2.ALKYD LINING 0 4, PHENOLIC LINING V. UNLINED 059. OTHER <br /> Ceeck Me Xem fw to ml ose <br /> OTHER CORROSION ❑ L ALLVUFACNRED CATHODIC ❑ ]. Fl9ERGLASS RFJNFORCEO PLASTIC 95. UNKNOWN 448 DATE INSTALLED ALS <br /> PROTECTION IF APPLICABLE PROTECTION <br /> O a. IMPRESSED CURRENT W. OTHER <br /> �(Creck pne Xem oNJ•1 0 2, SACRIFICIAL.MODE (For.bca/use any) <br /> SPILL AND OVERFILL YEAR INSTALLD 450 TYPE(Fwboama.*) 451' OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 42 <br /> (C�rkart Naf aDl✓Y) 0 1. SPILL CONTAINMENT 01.ALARM 0 3. FILLTUSESHUTOFFVALVE <br /> 0 2. DROP TUB` -_ 0 2 BALL FLOAT 0 L E PT <br /> 0 3. STRIKERPLATE <br /> :IV..TANK LEAKOETECTION(A%O$WPnoiGie moreYa4TDimN+m"be sLmry .nP the kda2ercyf'. <br /> IF SINGLEY/ALL TANK(G:eckKMas aDflA: dA IF DOUBLE WALL TANK Oft TANK WITH BLADDER(Cne6one Xem aNy): 45c - <br /> 01. VISUAL(EXPOSED PORTION ONLY) 0 5 AUNUAL TANK GAUGING DATG) ❑ 1. VISUAL(SINGLE MALL IN VAULT ONLY) <br /> DI AUTOAUTIC TANK GAUGIII 3(ATG) 05 VADOSE ZONE �❑ I CONTiNUGL$tNtERSTTTIAL MONITORING <br /> ❑3. CONTINUOUS ATG ❑ T. GROUNDWATER l!] 1 ALWVAL MONROIUNG <br /> 0 4. STATISTICA l' .NTORYRECONCMI TION(SIR)• ❑ 6. TANKTESTWG <br /> BIENNIALTANKTESTING Ogg. OTHER <br /> V.TANK CLOSURE INFORMAL ION I PERMANENT CLOSURE IN PLACE <br /> 'i ESTIMATEDDATE ST yA USED(rwtAOIDAY) 455 ESTUMTDOUANTOYO/IF.�L6UBSTANCEREAWNING 4% TANK FILLEDWITHINERT MATERIAL! <br /> ❑Y t <br /> ❑N Ll <br /> UPCF(1/99 revised) 6 FOTmerly SWRCB Form 8 <br /> VIAW <br /> �,l g, -� t <br />