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1NIFIED PROGRAM CONSOLIDATED F. 4 TANKS T1 1 �- UNDERGROUND STORAGE TANKS - TANK PAGE 1 (Two pages per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT Q,S.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(Same as FACILITY NAME nr DBA-Doing Business As)- 3. FACILITY ID: 1. Mhi1J 5'Ct'cET WL0 hm PM-x.15 z�IrLaiw: A- O p o 7 4 4 LOCATION WITHIN SITE(Optional) 431 [loo S. NIALO STP-EET PAWCEC.A, CA Q533'1 -rSRI xaled plot pjapt yittti(h Ioea f O s`�t`ril}ncTy7ding b1111di3gS and,randy rl2�tI�E16�s Ystr)i t iFfkf + ' . ! TANK ID# --�Q �+�z. TANK MANUFACTURER 437 COMPARTMENTALIZED TANK Yes No 434. U N L E Tvf(�� x EP/�E 7 If"Yes,-complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS (YEAR/MO 437. jqC10-1 20,000 ADDITIONAL DESCRIPTION(For local use only) 438 r r• �a�,p: i}-eaa�,.-e r '-�E ��, ' xtd �_�� 0'''' �Ir,cx x,,?g-ds,r 4;:r; �dfyy3: ,tn TANK USE sI�' ,,. ., _r,,...aac^.^r'r -v"s�;,••�xe-=As,rr�r�+ta,x.� �a J tr�f�a�;'� ,:, n 439. PETROLEUM TYPE 440. 1. MOTOR VEHICLE FUEL 91a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If checked,complete Petroleum Type) ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑ Ic, MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441. CAS#(liom Hazardous Materials Inventory page) 442. ❑ 4. HAZARDOUS WASTE �.-.(Includcs Used Oil) .: S106-9 ❑ 95.UNKNOWN. osTRUGai "' . a s-., `�°4w.` •'c, n-- TYPE OF TANK ❑L SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN DOUBLE WALL ❑4. SINGLE WALL M A VAULT ❑99. OTHER TANK MATERIAL-primary tank ❑I. BARE STEEL X3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary tank ❑ I. BARE STEEL FIBERGLASS/PLASTIC E18. FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ I.RUBBER LINED ❑3.EPDXY LINING Q S.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING X6.UNLINED ❑99.OTHER Check one item onl ) OTHER CORROSION ❑ I.MANUFACTURED CATHODIC 3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 449. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER lfA licable ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION FIT RPMENT: YEAR INSTALLED 452. (Check all that apply) 9I.SPILL CONTAINMENT 2 004- I.ALARM 200+n 3.FILL TUBE SHUT OFF VALVE _ >9 2. DROP TUBE 2st4 42.BALL FLOATLO o ❑4.EXEMPT 3.STRIKER PLATE TANK _ y z_ Y A.d_crap[Jon ofr . Mitt (11 thIIx. gercYr re , �vr ear Pi �c' Xai�s 'r; IF SINGLE WALL TANK 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑I. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL M VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE 2.CONTINUOUS INTERSTITIAL MONITORING [13. CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MA*r-AL MONITORJNG ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATI.ON I PERMANENT CLOSURE IN.PLACE ESTUVIATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457. gallons ❑Yes ❑ No UPCF hwfwrc-b(1/99)-1/4 idocs.or www.un htt :// Rev.02/16/00 http://www.unidocs.org