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01/02/2003 11:05 209577FP40 BOYETT PETROLEUM 2 l /3163 PAGE 04 UNIFIED PROGRAM CONSOLIDATED FORM TA,1`11C8 UNDERGROUND STORAGE TANKS-'SANK PAGE 1 (ta'0 aged per tank) Wge-of TYPE OF ACTION ❑1 Naw urp PrRMrr [1 4 AMENDED PERMIT Q 5 CHANGR OF TNFo1LMATION ❑ 6 TEMPORARY SITE CLOSURE (Cl-k-it--1y) El 7 PERMANENTLY CLOSED ON STT'E 3 RENEWAL PERMIT (Sveciy ron4on-(ot load Mc only) (speolry rewn-for laonl too only) ❑ R TANK REMOVED nw I BUSINF NAME ',R";F 'IL NAjor DBA-Doina Buskxm A4) FACILITY 1D:3 LOCATIbN WI IN SITE( on 431 1.TANK DX 4CRIPTiON (A scaled plot plan with the location of the UST system including bnllding_a and landmarks shall be submitted to the local agency.) TANK 1D# 432 TAN MA FACTURER 433 1 COMPARTMF,NTALIZED TAMC ElYes No 41A TA � �� I � If"Yci.oom,lete�m�by e4ea eotrq>a�ertt. DATE TNRTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 037 ADDITIONAL DES ON(p,lccal,so only) 431 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE I.MOTOR VEHICLE FUEL �dla, REGULAR UNLEADED Q 2. LEADED ❑5 MT PUP.L (If mmked complete rem>tmm7ypel ❑1b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED E]4. GASOHOL 0 99,OTNP.R ❑3. CHEMICAL PRODUCT COMMON NAME gm.Km,&-MnuLh i--.y page) 441 CASN(taco memdaa M4terlol.Inventory pW) ❑4. IIA7.ARDOUS WAST$ (lnehode.used 011) U o V / , ©95.UNKNOWN j V L/ }(J III. TANK CONSTRUCTION TYPE OF TANK Lj I. SINGLE WALL El 3. SINGLE WALL WITH U 5. SINGLE WALL WITH INTERNAL EILADDE R SYSTEM 1143 (Check one it-only) PXTERIOR MEMBRANE LINER ❑95. UNKNOWN \0-2 DOURLr WALL ❑4, SIGNI,E WAIL IN VAULT ❑99. OTHER TANK MATERIAL-pnmixy to* U 1. BARE STEEL El 3. FTBERGL.ASS/PLASTIC 0 5, CONCRETE 0 95.UNKNOWN 444 (Check one hem only) 2. STAINLESS STEEL. ❑4. STEEL CLAD W/FIBF_RCiLASS ❑A. PRP COMPTI9LP W/ DTA METHANOL ❑99.orruER REINFORCED PLASTIC(FRP) TANK MATCRIAI,-R40ndl ftk U 1. BARESTBEL 3. FIBERGLASS/PLASTIC Lj 5, CONCRSIE 95. UNKNOWN 445 (Cheek one hem only) ❑2. STAINLESS STEEL ❑4, STF,F,.L CLAD WTIt;FRGLASS O k FRP COMPTI8LE W'100%MFMANOL ❑!M,OTHFR REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING El 1.RUBBER LINED Ll 3.EPDXY LINING .�/ 5.GLASTN S LTNG 95,UNKNOWN 446 DATE INSTALLED '14" OR COATING Ll2 ALKYD LINING ❑4 PHENOLIC LINING l�6 UNLINED ❑v9 OTMM (Check ono itam onh•) / (FM foal m �ty) OTHER CORROSION ❑1 MANt1PACFURED CAT7AODIC ❑3 Pll)rRGI,ASS REINFORCED PLASTIC ❑95 UNKNOWN 44''1 DATE INSTALLED 409 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT 99 OTHER I AYe- (Mtek tom=i'm only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE 451 OVERFILL PROTECTION EQL7PMENT,YEAR INSTALLED 1S2 (Chock all that.my) t 1 SPILL CONTATNMEN r I ALARM X3 FILL TUBE SHUT OFF VALVE 42 DROP TUBE 2 BALL FLOAT ❑4 EXEMPT 3:IRiKER.PLATE IV.TANK LEAK DETECTION(A desvlptlon of the m Iwing Mndnm shall he P.O m ned in the anent messy,) IF SINGLE WALL TANK(Cb**nilthunapply) 437 IF DOUBLE WALL TANK OR TANK W[TH BLADDER 454 (Chock ono item any) ❑1 VISUAI,(E)(POSED PORTION ONLY) 5 MANUAL TANK GAUGING(MTG) O 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE J5(t CONTINUOUS TNTFRSTITIAL MONITORING ❑3 CONTINUOUS ATG Cl 7 OROUNDWATER ❑3 M,4NUAL MONITORING ❑4 STATISTICAL TNVF,NTORY RECONCILIATION O B TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE I NFORMATION/PERMANENT CLOSURE,IN PLACE ESTIMATT;O DATE LAST USED(YR/MO/DAY) ASS ESTIMATED QUANTITY OF SUBSTANCE REMAINTNG 456 TANK FILLED WITH INERT MAT'ERTALT 457 E3110M, ['Yea ❑ No UPCF(12M revised) I O Formerly SW.RCB Form B