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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE I <br /> E (Two pages per tax* <br /> Page-of <br /> TYPE OF ACTION 13 1.NEW PERMIT ❑ 4.AMENDED PERMIT [3 s.CHANGE OF NpoRmAITON E3 6.TEMPORARY TANK CLOSURE 430. <br /> ([bock one item mly). [3 3.RENEWAL PERMIT [1 7.PERMANENTLY CLOSED ON SITE <br /> (Specify (Spccify-n) [3 8.TANK REMOVED <br /> BUSINESS NAME(Sow u PACILMYNAME or DBA-Doing Busken A2) 3, FACILITY TD: <br /> Safeway Inc. <br /> LOCATION WITHIN SITE(optimal) 431. <br /> NE comer of West 11th Street and Corral Hollow Road <br /> ART, <br /> ....I..... <br /> .......... <br /> TANK ID# 411 1 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK M Yes No 434. <br /> 2. Modem Weldinjz Co.Inc. If"Yeg"Complete ou pop for each a=qMtrneal <br /> DATE INSTALLED 415. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437. <br /> (YEAR/MO) <br /> 2002 March 2.0�- VD,k,a 0 <br /> ADDITIONAL DESCRIPTION(For low use-mbr) 438. <br /> TANK USE 439 PETROLEUM TYPE 440. <br /> CM 1, MOTOR VEHICLE FU13L 19 1&, REGULAR UNLEADED 13 2. LEADED ❑5. JET FUEL <br /> (Ifthacked,carnpictc Petroleum Type) Grib. PREMIUM UNLEADED 0 3. DIESEL ❑6. AVIATION GAS <br /> [3 2- NON-FUEL PETROLEUM C3 lc. MIDGRADE UNLEADED 04. GASOHOL [3 99.OTHER: <br /> [3 3. CHEMICAL PRODUCT COMMON NAME(f--ff-anlou Matenals laymorY Pow) 441 CAS#(&arn Huwd=Uaterials Inventory page) 442. <br /> 0 4. HAZARDOUS WASTE REGULAR UNLEADED 8006-61-9 <br /> (Includes UNd Oil) <br /> [3 9S.UNKNOWN <br /> TYPE OF TANK 1. SINGE EWALL Lj 3. SINGLE WALL WITH EXTERIOR U5- SINGLEWALL INTERNAL TERNAL BLADDER SYSTEM 443. <br /> (Check one item only) MEMBRANE LE4M [:3 95. UNKNOWN <br /> 2, DOUBLE WALL 0 4. SINGLE WALL IN A VAULT 99. OTHER <br /> -TA-NK MATERIAL-pi..y tank 1. BARE STEEL U 3. FIBERGLASS i PLASTIC [3 5. CONCRETE u 95 UNKNOWN 444, <br /> (Check one item only) El 2. STAINLESS STEEL [3 4. STEEL CLAD W/F[BERGLASS ❑8. FRP COMPATIBLE [3 99.on-=: <br /> REINFORCED PLASTIC(FRP) - W/100%METHANOL <br /> TANK MATERIAL lank [3 1. BARE STEEL 293. FIBERGLASS I PLASTIC [I S. FRP COMPTIBLE W/100%METHANOL n95-.UNKNOWN 445. <br /> (Check one item only) ❑2, STAINIMS STEEL[3 4. STEEL CLAD W/PMERGLAS S []9. FRP NON-CORRODABLE JACKET El 99.OTHER <br /> REINFORCED PLASTIC(FRP) [3 10. COATED STEEL <br /> MS. CONCRETE - <br /> TANK INTERIOR LINING [11.RUBBER LINED Cl 3.EPDXY LINING 5'-GLASS LINING 95.UNKNOWN 446. DATE INSTALLED 447. <br /> ORCOA G LINING2.ALKYD LG 134.PHENOLIC LINING 6.UNLINED ❑99.OTHER <br /> Check <br /> only) <br /> OTHER CORROSION [3 I.MANUFACTURED CATHODIC JR 3.FIBERGLASS REINFORCED PLASTIC 95.LIM40WN 448. DATE INSTALLED 449 <br /> PROTECTION PROTECTION 0 4.BOTESSED CURRENT ❑99.OTHER <br /> (IfAMlicable) [12.SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. <br /> (CJleck all that apply) IM 1.SPILL CONTAINMENT 2001_ M-Tite85000 0 1.ALARM ❑S.FILL TUBB SHUT OFF VALVE- <br /> ®2.DROP TUBE 2001_ 01YW61T-7368 [3 2.BALL FLOAT 4.EXEMPT <br /> 3.STRTM PLATE Tank Mfg ModentWeldin <br /> .......... <br /> IF SINGLE WALL TANK 453- IF DOUBLE WALL TANK OR TANK WITH <br /> BLADDER 454, <br /> (Check all that apply) (Check one item only) <br /> []1.VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) [3 1.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> Cl 2.AUTOMATIC TANK GAUGING(ATG) 13 6.VADOSE ZONE 0 2.CONTINUOUS INTERSTITIAL MONITORING <br /> []3.CONTINUOUS ATO [3 7.GROUNDWATER ❑3,MANUAL MONITORING <br /> 0 4. STATISTICAL INVENTORY RECONCILIATION 0 8.TANK TESTNG <br /> (SIR)+BIENNIAL TANK TESTING ❑99,OTHER <br /> 4", ESTIMATED QUANTITY OF SUBSTANCE REMAINING 4 TANK FILLED WITH INERT MATERIAL? 457, <br /> ESTIMATED DATE LAST USED(YRoMO(DAY gallons 0 Yes 0 No <br /> UPCF hwfwre-b(1/99)-1/4 bttp:/1,n-ww.un1docsorg Rev,02116/00 <br /> 6 -d 0026 13rN3SUI dH WdGip :-I, 2002 60 NUC <br />