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__ iFIED PROGRAM CONSOLIDATED F6, TANKS UNDERGROUND STORAGE T - TANK E 1 S' (two pages per tank) Page hof j 1 TYPE OF ACTION ❑ I NEW SITE PERMIT ® 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEjMPORARY SITE CLOSURE (Check otte dem only) ❑ 7 PERMANENTLY CLOSED ON SITE Q 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 BUSINESSNAME(SameasFACILITYNAMEorDBA-DoingBusinessAs) FACILITY ID: _ T- T-7 ' Van De Pol Ente rises LOCATION WITHIN SITE(Opticnal) 431 Northwest side of site I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system inck ding buildings and landmarks shall be submitted to the local agency.) TANK ID#,"3 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 UNKNOWN TTA OUNKNOWN If"Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1988 i'l I OCO 1 ADDITIONAL DESCRIPTION(For local use only) 438 11.TANK CONTEN S TANK USE 939 PETROLEUM TYPE 440 [&L MOTOR VEHICLE FUEL ©Ia. REGULAR UNLEADED ©2. LEADED ❑5. ]ET FUEL (Ifmarked complele Petroleum Type) []]b. PREMIUM UNLEADED ❑3. DIESEL [:16. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑ lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE UNKNOWN (Includes Used Oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ I. SINGLE WALL ❑3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one hem only) EXTERIOR MEMBRANE LINEI t ❑95. UNKNOWN ®2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank ❑1. BARE STEEL. 03. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPTIBLE WA00%METHANOL ❑99.OTHER REINFORCED PLASTIC FRP) TANK MATERIAL-secondary tank [j1. BARE STEEL ®3. FIBERGLASS/PLASTIC El5. CONCRETE -195. UNKNOWN 945 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLA S ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(F ) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING [1 1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING [:195.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 06 UN D ❑99 OTMR (For local use only) (Check one item only) 8 DATE INSTALLED "99 OTHER CORROSION [:I [MANUFACTURED CATHODIC [:13 FIBERGLASS REINFOR ED PLASTIC ❑95 UNKNOWN "S PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(Iceal use only) 45I OVERFILL PROTECTION EQUIPMENTNEAR INSTALLED 452 (Check all that apply) ®1 SPILL CONTAINMENT 2003 ®1 ALARM 2003 ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 ®2 BALL FLOAT 2003 ❑4 EXEMPT ®3 STRIKER PLATE 1988 IV.TANK LEAK DETECTION(A description ofthe monito'ng program shall be submiteed to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG 1 ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OT14ER IV.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED(YRIMOIDAY) ass Q gallons ❑Yes ❑ No UPCF(12199 revised) 10 Formerly SWRCB Form B