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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 d <br /> ( 'p-ce�Ta,k) <br /> va9e _ a <br /> TYPE OF ACTION 01. NEWSGEPEmff D 4,AMENOEOPER.VIT 0 S. CHANGE OF NFORMATIONI 0 6, TEMPORARY SITE CLOSURE <br /> /[neck.dem poly) D 7. PERMANENTLY CLOSED ON SITE <br /> [11RENEM4PL PERMIT (Spe>ry reasoe-«Ucalvu ony) (Spedry rJlarge-Mbcalvu oNy) M1d�e. TANKREMOVED 45C <br /> N <br /> SINEW AME IS as FACILITY NAM OBA-DovK 9usin<fa As) ] FACILITY We p2 <br /> 1 'IIS <br /> �1�Cl� RUc k aSi , <br /> LOCATION SMTHIN SITE(Op Sonaq <br /> 1.TANK DESCRIPTION (. sryM y4t FGn x�:D`ObCaSrJl cline VST system lrlvQny.Evld'nqs arG lariC•nasLAbe Mr.Jt4•dlD C.e katal a9exyl <br /> TANK 10e 432 TAVX G=;.;TAKER w 0 Na 4b <br /> L ` i � COMPARTMENTALIZEDTANK ❑Y. <br /> L.i ///{AA tl'Yes,oanDle:e aye Da9e lar earl mmparanmt <br /> OAT-E�� ED(YEAPA.10) 415 T CAP:dry IN GALLONS 4b I NUMBE Or COAIPARTMCMS 43. <br /> V�A II 201 ©OGS N A <br /> apDlm pESCRIPTION IFcr dful vie dVy) r'T" <br /> IL TANK CONTENTS <br /> ���� TANKUSE 439 PETROLEU'AT, E 4t: <br /> 9�1. MOTORVEHt'LEFUEL I 01a. r--GUTAR UNLEA= 0 22. LEADED 0 5. JET FUEL <br /> V.,m+ne8,.mPlsle Pe:Neom Type) I Dib PREMIUM UNLEALCE] M]. DIESEL ❑ S. AVIATION FUEL <br /> 0 2. NON-FUELPETROLEUM 11 Ic M1'dOGRADE U'lLEA.E7 ❑ a. GASOHOL ❑99. OTHER <br /> ❑ ] CHEMICAL PRODUCT N1 I CASS/hom HaTarkws Ma.•enak lnrnrorypa9q 4:2 <br /> I COMMON NAME(Imm H+:arcus Mandah lm•>NarypaF<) (/�\(/�� aa� a1/ /] -///� <br /> 4. HAZARDOUS WASTE(IrU✓.e1 , _-ISL �olJ ,�+_` a I <br /> 095. UNKRDVN I <br /> -- - III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1 51NGLE VIALL 0 ]. SINGLE WALL V T 5. SINGLE W.LLL VATH INTERNAL BLADDER SYSTEM 4J <br /> (Lneck me<em a:ryi 1,1�Y2 DOUBLE V/ALL EXTERIOR MEMBRANE LINER D95. UNXNOWN <br /> D 4. SINGLE WALL IN A VAULT 0 99, OTHER <br /> TANK AATERAL-prknary wk 1 BARE STEEL <br /> 03 FIBERGLASS/PLASTIC D 5. CONCRETE 095. UNMOVN <^ <br /> (Cn oee item only) 0 1 STAINLESS STEEL D 4. STEEL CLAD WIFIBERGLASS 118 FRP COMPATIBLE WlIW4 METHANOL 059. OTHER <br /> REINFORCED PLASTIC FRP <br /> TANKMATERAL-ssv nary lank 1 BARE STEEL 01 FIBERGLASS I PLASTIC 06 FRP COMPATIBLE WIl00A METHANOL 5. UNK40WN 4,5 <br /> fc'. c we dem only/ 0 2, STAINLESS STEEL ❑ 4. STEEL CLAD VLSIBERGLASS 09 FRP NON�CORROOIBLE JACI51 ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) 010. COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING D 1_ RUBBER UNEO ❑ ] EPDXY LINING. 0 5 GLASS LINING 095. UNKNOWN 4416 DATE INSTALED 4417 <br /> OR COATING <br /> ❑ 2.ALKYD LINING ❑4.PHENOLIC LINING a,/6-UNLINED 099. OTHER fak:olvu <br /> Deck <br /> one aemo <br /> I OTHER CORROSION 0 I. MANUFACTVREO CATHODIC ❑ 1 FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN 448 DATE INSTALLED u9 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑a. M➢RESSEO CURRENT ❑99. OTHER (£orbw vse o5dy) <br /> I(Ueek on.Bem O/dy) ❑ 2. SACRIFICIAL(NODE <br /> SPILLANOOVERFILL YEM NST:J-LD 45(1 TY➢E(Fcebcal usa oNy) 451OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED +=2 <br /> (Cnr_k M lhst.,PW 0 1. SPILL CONTAINMENT 0 1.ALARM 0 ]. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE <br /> 0 2, BALL FLOAT_ D 4. EXEMPT <br /> 0 S. STRIXERPLATE <br /> . c.IV,.TANK LEAK DETECTION(A EespnPecn MCxmDmTna50'DGr+m snaPbe sWmNM btnekwla9ercyl' <:. <br /> IF SINGLEWALL TANK(CnarkM WfaPlM: 45] IF DOUBLE WALL TANK OR TANK WITH BlAOpER(GAeck pneden. prtlyJ: 454 - <br /> 01, VISUAL(EXPOSEO PORTION ONLY) 0 5 MANUALTA4KGAUGING(MTG) ❑ 1. VISUAL(SINGLE LNALL IN VAULT ONLY) <br /> 02. AUTOMATIC TANK GAUGING(ATG) 05 VADOSE ZONE 022 CONTINUWS INT RSTTAL MONITORING <br /> 03 CONTNUOUSATG 0 T GROUNOVIATER 111]. MANUAL MONITORING <br /> 04. STATISTICAL INVENTORY RECONCILIATION(SIR) 05. TANKTESTING <br /> BIENNALTANKTESTING 099. OTHER <br /> V.TANK CLOSURE INFORMATION)PERMANENT CLOSURE <br /> ESTIMATED DATE LfST USED( MAOIDAY) 455 EST0.ArDUU� SUBSTANCE REMAINING 4% TANK FILLED Vrt INERT MATERIAL7 <br /> Ls/^N ❑y ❑N // <br /> IFCF(1199 revised) 6 Formerly SWRCB Form B <br />