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• 'FIED PROGRAM CONSOLIDATED FOP �Lq z t TANKS T11T1 L:} UNDERGROUND STORAGE TANKS - TANK PAGE 1 j (TWD pages per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT J35.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 or DBA-Doing Business As) 3. FACILITY ID: 1. MN10 STIL66T APUC AM QM- IUS zN7e"f�ISE LL I F- F So 1() [S-1 14 M64 LOCATION WITHIN SITE(Optional) 431. 1100 S MAit i SVLE-ET MA,NtEGI°�, CA 9S3,3-1 � �� - ;�, }�- ��,� ;� ,"�s""S DES �.��, s �.,�` ,� _�, � --�{ :, •,� H ? � p1atplalYw(twth6l�ocationlo t_ ', rs St�dludtng6ulfditlgga>ydl� a.`an[ M TANK ID# n` O` 432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK ❑Yes No 434. M,O G A DF, A 1 'x E ft S If"Yes,"complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS (YEAR/MO) 437 v9gT/07 12, b0_0 -- ADDITIONAL DESCRIPTION(For local use only) 439. L ! aGiS. - ap yS-a?y� J ,ate11 _". 1.1- 1 7�� I .�J"` a K. 7•tom; Y i4 "' .:{.'^.Y, '� �- :T.,t.. ,{'. ?ul V .'t' [ f. 'f,:kJll CAINFiY•\ A er. .y,•- may�.ia. ';- 5fe +i. s., ruSn - -.£:: .G..c31> -Wti". .a:x!t•.r.'L ..'.ffi-, iY. 1•.r+Y` -' 13-'-. N. TANK USE 439• PETROLEUM TYPE 440, 1. MOTOR VEHICLE FUEL ❑1 a. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (lfchecked,complete Petroleum Type) ❑ lb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAM E (from Hazardous Materials Inventory page) 441. CA$#(from Hazardous Materials Inventory page) 442. ❑ 4. HAZARDOUS WASTE .jIncludes Used oil) 4,,1:& 95.uNxxowN TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN 2. DOUBLE WALL ❑4. SINGLE WALL M A VAULT ❑99. OTHER TANK MATERIAL-primary tank El I. BARE STEEL 3. FIBERGLASS/PLASTIC [15. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2.,STAINLESS STEEL [:14. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC(FRP) W/100%METHANOL TANK MATERIAL-secondary tank ❑I. BARE STEEL 3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/I GO%METHANOL ❑95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FTBERGLASS [19. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING g6.UNLINED ❑99.OTHER Check one item only) OTHER CORROSION ❑ I.MANUFACTURED CATHODIC 3.FIBERGLASS REINFORCED PLASTIC E195.UNKNOWN 449. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER f Applicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR fNSTALLED 452. (Check all that apply) .SPILL CONTAINMENT L ALARM I-UV4 P3.FILL TUBE SHUT OFF VALVE DROP TUBE 2.BALL FLOAT 2�4 ❑4.EXEMPT 1 f3.STRIKER PLATE o }r IV TTKLEAK_DETE'>sTI _ 7 F i. {__ t :(A descrtp ion of the monttonng program shall be goljmit a 16 t46 locdf agersc IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑ I.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE We X CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTIMJOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE STIMATED 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 h"p://www.unidoes.org Rev.02/16/00