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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (TV-Pam Per w1k) <br /> Page_Df <br /> TYPE OF ACTION ® 1.NEW PERMIT ❑ 4.A vMNDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6,TEMPORARY TANK CLOSURE 430. <br /> (Cheek ooa itun mly) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENT2Y CLOSED ON SITE <br /> (specify cCOm,) (specify meson) ❑ 8.TANK REMOVED <br /> BUSINESS NAME(same u FACILITY NAME or DDA-Doig Buda=As) 3. FACILITY ID: 1 <br /> Safeway Inc. ' <br /> LOCATION WITHIN SITE(Opuaw) 431_ <br /> NE comer of West 1 lth Street and Corral Hollow Road111.11.1 x <br /> 7 <br /> -011 <br /> cc^^• <br /> TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK I I Yes M No 434. <br /> 1. Modern Welding Co.Inc. If"fes",convlom me page foresch compamneac <br /> DATE INSTALLED 433' TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS 431. <br /> (YEAR/MO) <br /> 2002 March 20,000 one <br /> ADDITIONAL DESCRIPTION(Fcriocal uac only) 438' <br /> =r <br /> e <br /> TANK USE 439' PETROLEUM TYPE 440. <br /> ® 1. MOTOR VEHICLE FUEL ®t Is. REGULAR UNLEADED ❑2. LEADED [IS. JET FUEL <br /> (ucheck4 conPtote Parolarm Type) ❑Ib. PREMIUM UNLEADED [13, DIESEL ❑6. AVIATION GAS <br /> ❑ 2. NON-FUEL PETROLEUM ❑10. MIDGRADE UM.EADED ❑4. GASOHOL ❑99.OTHER: <br /> [13. CHEMICAL PRODUCT COMMON NAME (tram if-dour Material.invmtmy pp) 441. CAS#(from Haaardous M="&Invuoory page) 441 <br /> ❑ 4. HAZARDOUS WASTE REGULAR UNLEADED 8006-61-9 <br /> (Indudes Used oil) <br /> ❑ 95.UNKNOWN <br /> {.' 'i.Z:. f'iY"•" .: Y F;,siJ3L ...' F"'�T.M!-` tw.,...rv� �,Y CU L,� ':'fix, 'J.. F�Kt N `„^�:ky <br /> TYPE OF TANK 1. SINGLE WALL w 3. SINGLE WALL WITIi EXTERIOR S. SINGLfi WALL WTTH INTI RNAL BLADDER SYSTBM 443. <br /> (Check 011e item only) MEMBRANE LINEA ❑95. UNKNOWN <br /> 2.DOUBLE WALL 4. SINGLE WALL IN A VAULT 99. OTHER <br /> TANK MATERIAL_gimKy tank 1.BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 444• <br /> (Check one item only) ❑2. STA24MS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: <br /> REINFORCED PLASTIC W/]00%METHANOL <br /> TANK MATERIAL-secondary tank 0 1. BARE STEEL IS 3. FIBERGLASS I PLASTIC C3 8, FRP COMPTIBLE W/10091 MEITIANOL 95.UNKNOWN 445. <br /> (Cbeck one item only) ❑2. STAINLESS STEEL❑4. STEEL CLAD W/FMERGLASS ❑9.FRP NON-CORRODABLE JACKET ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) ❑to. COATED STEEL <br /> S. CONCRETE <br /> TANK INTERIOR LINING 0 1.RUBBER LINED Li 3.EPDXY LINING5.GLASS LINING 95.UNKNOWN 446. DATE INSTALLED 447. <br /> OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LIVING ®6.UNLINED ❑99.OTHER <br /> Check one item onl <br /> OTHER CORROSION 1.MANUFACTURED CATHODIC 3.FIBERGLASS REINFORCED PLASTIC 95.UNKNOWN 448, DATE INSTALLED 449. <br /> PROTECTION PROTECTION [34.IMPRESSED CURRENT [399.OTHER <br /> llcabLe 2.SACRIFICIAL ANODE <br /> SPILL AND OVERIT.L YEAR INSTALLED 450. TYPE 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. <br /> (Check all that apply) IN I.SPILL COVTADQAE 1T ^2001_ Phil-Tite85000 ®1.ALARM _ ❑3.FILL TUBE SHUT OFF VALVE <br /> ®2.DROP TUBE 22001_ OPW 61T-7368 ❑2.BALL FLOAT_ 4.EXEMPT <br /> !!!0 <br /> odem�. AprM'�.d-a•s 6H,IF SINGLE WALL T . IF DLE WALL TANK OR TANK WITHBLADDER as4. <br /> (Check all that apply) ( econeitem only) <br /> ❑1.VISUAL(EXCTOS ❑5.MANUAL TANK GAUGING(MTC) 1. AL(SINGLE WALL IN VAULT ONLY) <br /> ❑2.AUTOMATIC TA ❑6.VADOSE ZONE ®2.CONTINUOU3INTERSTITIAL MONITORING <br /> ❑3.CONTINUOUS ATO ❑7.GROUNDWATER ❑3.MANUAL MONITORING <br /> ❑4.STATISTICAL INVENTORY RECONCILIATION ❑S.TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING ❑99.OTHER ;�1 <br /> ,carr 4 <br /> r. <br /> ESTIMATED DATE LAST USED(Y%MO/DAY) 453, ESTWATED QUANTTTy OF SUBSTANCE REMAD41NO 456. TANK FILLED WITH INERT MATERIAL? 457. <br /> gallom ❑Yes ❑No <br /> UPCF hwfwtrib(1199)-L4 bttpJ/www.unldocLorg Rev,02/16100 <br /> Z 'd 0026 13r83SU-1 dH Wd6b :b ZOOZ 60 WIC , <br />