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{ IED PROGRAM CONSOLIDATED FO r 2 0 yy 7 TANKS UNDERGROUND STORAGE TANKS --TANK PAGE 1 . (two ages tank) TYPE OFAC TION NEW SITE PERMIT C34 AMENDED PERMIT' ❑ 3 CHANGE OF INFORMATION p+6a at (px,ams ❑ b TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE BSINESS NAME ❑ , RENEWAL WALPBRbLT (spe�trQioeu,�ao (Sr�Y -'at wwm,mly) ❑ g TANKREMOVFD 436 NET (UM FA NAME at DHA-Doug Bwlam AN) 3 FA=1D.- Impe 7441 LOCATION WITHIN SITE(Oat) �///}}}� ®Y� woQr 471 L TANK DESCRIPTION (A sealed plot plan With the location of the USTs TANK ID 4 43'2 ystem inchlding huildillga and htadmacica shall be ailbmitted to the local agency.) 'r TAN/KMANUFACTURER 433 COMPARTMENTAIJZED TANK Xsa o 4J4 V �1 1101I © V ce,compmm as pap for ace omnpgvmm BATINST D O) � TANK CAPACITY IN GALLONS 4M NUMBER OF COI�ARTMENTS 437 !vim ADDITIONAL DESCRIPTION(FQ tow uaamdy) 436 TANK USE 439 PETROLEUM TYPE U.TANK CONTENTS ❑I.MOTOR VESICLE FUEL440 ❑1 L REGULAR UNLEADED (3 2. LEADED ❑S. 7 FUEL {ft eompde+e'peaoleumType) ❑Ib. PREMIUM UNLEADED ❑3.DIESEL ❑$.AVIATION FUEL 2 NON FUEL PETROLEUM ❑1 a MIDGRADE UNLEADED ❑4. GASOHOL &W9.OTHER ❑ CHEMICAL PRODUCT COMMON NAME gkom HmI I4areriakhcI 114. HAZARDOUS WASTE F`f°) 441 CASA(rmm t Matalata Invmovy page) 442 ❑95.UNKNOWN HL TANK CONSTRUCTION TYPE OF TANK . SINGLE WALL 0 3. SINGLE WALL WITH U 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (ewe may) EXTEJLIOR MMORANE LINP.R ❑.95. UNKNOWN ❑2. DOUBLE WAIL ❑4.SLGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary wit BARE STEEL 3. FIBERGLASS!PLASTIC , 5.CONCRETE U 95.UNKNOWN 444 {csrd�ma s�w4I ❑2. STAINLESS STEEL ❑4. STEEL CLAD WROEROLASS ❑1.FRP COMPrunz W/1 00%METHANOL ❑99.b THER REINFORCED PLASTIC(FRP) TANK MATERIAL-aeaad I 9w* J.BARE STEEL L13. FIBERGLASS/PLASTIC 0 5. CONCRETE El 95.UNKNOWN 445 (Check 2. STAINLESS STEEL ❑4. STEEL CLAD WIFIBEROLAS.S E11- FRP COMPTIBLE w/J00%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL. v ❑5.CONCRETE TANK INTERIOR LINING LJ 1.RUBBER LINED 0 3.EPO)IY LINING El 5.GLASS LINING U 95.UNKNOWN 445 DATE INSTALLED M? i OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING UNLINED ❑99 OTHER (aKctmciumayJ,1 I {Fm tical un w]y) OTHER CORROSION ❑1 MANUFACiURM CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 446 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (awck ane tsar�!') I ❑2 SACRIFICIAL ANODE . (Far local we amly) SPILL AND OVERFILL YEAR INSTALLED 459 TYPE(IIW..1) 451 OVERFILL PROTECTION EQUIPMENT-.YEAR INSTALLED 452 Th-kaa dwgoy) ❑1 SPILL.CONTAINMENT 131 ALARM ❑3 FILL TUBE SHUT OFF VALVE ` 3 ❑2 DROP TUBE 132 BALL FLOAT f (34 EXEMPT ❑3 STRIKER PLATE ^111-f i IV.TANK LEAK DETECTION(A dna.ipdan eeratioed m"local asoxy.) IF SINGLE WALL TANK((batt a1J&&L VpEy) 4D IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ea on,I;ium only) 131 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SI NOLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATO) ❑b VADOSE ZONE ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATO Cl 7 GROUNDWATER ❑3 MANUAL MONTTORINO Cl 4 STATISTICAL INVENTORY RECONCILIATION ❑1 TANK TESTING (SIR) BIENNIAL TANK TESTING 11119 OTHER N� ' IV.TANK CLOSURE INFORMATION/'PERMANENT CLOSURE IN PLACE ESTIAATED DATE LAST USED(YR/MO/DAY) 473 ESTIMATED QUANTITY OF SUBSTANCE REMAINING TANK FILLED WITH INERT MATERIAL? 4" ❑Yea ANO UPCF(12199 revised) 10 Formerly SWRCB Form B