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uWD PROGRAM CONSOLIDATED F010 01f/+S('� <br /> TANKS <br /> UNDERGROU" STORAGE TANKS - TANK P 1.1 D (Two pages per tank) <br /> Page_of <br /> S.AMENDED PERMIT ❑ 5.CHANGE OF Lr-FOR-�lAI DIN ❑ 6.TEMPORARY T.V`L CLOSURE alo. <br /> TYPE OF ACTION �NEW PERJ'UT ❑ [27.PERMANENTLY CLOSED ON 517E <br /> (ch.k aC Lead) ❑ 3.RE`tEW AL PERMIT ❑ 8.TANK REMOVED <br /> (5Ps'N�aon) (seen%1of°nl 1. <br /> BUSINESSNAME(Smea FACRJTYNAME"rnBA-oo;"c B"za^') 3. FACILITY[D: <br /> e C/ I e/' SI�G/C16.�/ -431. <br /> LOCATION W IN SITE(OP-w) <br /> L TANK DESCRIPTION <br /> YPA (A sated Plot Ian With the location of the UST system including buildings and landrnar56 sball be subtrdtted to the local agency.) <br /> a33FACTUR . CObtPAM <br /> RTENTALIZED TANK Yes No 434. <br /> TANK IDX '}- TANK\IAN FA KR <br /> p if"Y.-cwrylM OM page to,CCL can. <br /> ' a a a3s. TtV`1K CAPACITY IN GALLONS aM I N�ffiE2 OF COMPARTMENTS q7. <br /> DATE INS <br /> uTALLED 6!7 <br /> ADDITIONAL DESCR&I IGN(Far tical cast Dolt) <br /> H.TANK CONTENTS <br /> caw. <br /> TANK USE 439. PETROLEUM TYPE <br /> ❑ 1. MOTOR VEHICLE FUEL C2 la REGULAR UNLEADED ❑+2. LEADED Cl 5. JET FUEL <br /> 6. AVLATTON GAS <br /> (IreLCkW mnolM perakvm Type) <br /> [3 1b. PREMIUM UNLEADED E33. DIESEL C3 99.OTHER: <br /> ssi <br /> ❑ 2. NON-FL-EL PETROLELN E3 1c. MIDGRADE UNLEADED [Z 4. GASOHOL O CAS#0,0.Hazvd..,mu. '1°venmry Pnee) <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Haardaaa m..1,t°1e°fO1Y Wce) <br /> ❑ a. HAZARDOUS WASTE <br /> (h,Wd Uteaoio <br /> �95.1JNKVOR\ <br /> III.TANK CONSTRUCTION sa3 <br /> . SIGLE WALL 3. SW ALL WITH EXTERIOR 5. SL�GLE W ALL WITH INTERNAL BLADDER SYSTEM <br /> TYPE OF TANK NMEMBRANE LINER ❑95. L�'KNOWN <br /> SING <br /> (Check aw item only) a s. SINGLE W ALL IN A VAULT ❑ 077BR saa. <br /> ❑?. DOUBL.WALL ❑ 5. CONCRETE 95.UNKNOWN <br /> TANK MATERIAL-p"� , BARE STEEL J. FBERGLASS/PLASTIC <br /> s. FRP COMPATIBLE ❑99.OTHER: <br /> ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FBERGLASS ❑ W-,lg1Y.METHANOL <br /> tCled<ae°m'°nb'1 REINFORCEDPLASTIC ) <br /> TANK MATERIAL-secondary teak 1. BARE STEEL <br /> 3. FIBERGLASS/P3.1ST1C s. FRP CO3�1'BLE W/IOB%METHANOL 95.UNKNOWN aas. <br /> (Cheek one imm only) ❑2. STAINLESS STEEL❑4• STEEL <br /> REINFORCED f FIBERSTIC(FRP) ❑LASS [3 90. COATED STEEODABLE JACKET ❑99.OTHER <br /> ❑5. CONCRETE g5,UNKNOWN w6. DATE INSTALLED aa7 <br /> 3.EPDXY LINING 5.GLASS L,NL`iG ❑91 OTHER <br /> TANK INTcR10R LL\r0 1.RUBBER LINED a.P[SENNOUC LINING <br /> OR COATIiG ❑2.ALKYD LINING ❑ � � a 7 DATE INSTALLED a49. <br /> Check one imm onlv) 3.FIBERGLASS REINFORCED PLASTIC 5.UNKNOWN <br /> OTHER CORROSION 1.MANUFACTURED CATHODIC ❑4.IMPRESSED CURRENT E399.OTHER <br /> PROTECTION PROTECTION 4si <br /> + <br /> SACRIFICIAL ANODE 451. O\ERI-' PROTECTUON EQUIPMENT: YEAR INSTALLED <br /> f Awlinble) ❑- IFIy INS7 D 450. TYPE <br /> SPILL AND OVERFILL ���,M.IJ,� ❑ 1.ALARM E3 3.EXEMPT t TUBE SHUT OFF VALVE <br /> (Check all trot apply) ❑1.SPILL CONTAINMENT =rw /k [03+BALLFLOAT [2<. <br /> ❑7 DROP TUBE <br /> ❑3.b-TRIKER PLATE Iv.TANK LEAK DETECTION <br /> (A description of the monitom rogrant shall be Submitted m the local agency"I <br /> 4U.453. 1F DOUBLE WALL TANK OR TANK WITH BLADDER <br /> IF SINGLE WALL TANK (Lbeck tme item only) <br /> (Check all that apply) S MANUAL TANK GAUGING(MTG) ❑ 1-VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(ECPOSED PORTION ONLY) ❑ ' ❑±CONTINUOUS INTERSTITIAL MONITORING <br /> ❑2. ALTOMATIC TANKGAUGING(ATG) C2 6.VADOSE ZONE <br /> [3 3.CONTINUOUS ATG <br /> [27.GROUNDWATER C33.MANUAL MONTTORJNG <br /> ❑i.STATISTICAL 0,VENTORY RECONCILIATION 13 9.TANK TESTING <br /> ❑99.OTHER <br /> (SIR)-BIE\11AL TANK TESTING <br /> V.TANK CLOSURE INFORMATION/ PERMAINF�NT CLOSURE EN PLACE as7. <br /> ash. TANK FILLED WITH INERT MATERIAL.' <br /> ass. ESTLMATE1)QUANT? Y OF SUBSTANCE REMAL ❑Yes ❑ No <br /> ESTIMATED DATE LSI USED(YRMO/DAY) gallata <br /> -- <br /> Rev.OJlt <br /> ham;//www.unidocs.org <br /> UPCF hwfwrc-b(I/99)-IIS so <br />