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06/11/2004 14:44 209-836- 130 PAG 03 <br /> UNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS= TAINK PAGE f (two paps per tank) <br /> Page_et— <br /> Y SITE <br /> SURE <br /> TYPE OF ACTION CJ 3 NEW 51�IIr PEIL411T ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION C3 7 PERMAN PERMANENTLY CLOSED ON SITE <br /> (Check one imm only) Q STANK REMOVED 430 <br /> I reason-Ibr local vac ortky) <br /> C] 3 RENEWAL PERMIT (3vIIY Kin- laal.ueonly) ISOR(Y t <br /> FACIf.ITY ID: <br /> BUSINESS NAME(lama w FACILI.Y NA.�(E o D9n"Doing flusinsR&As} 5 <br /> [n 431 <br /> LOCATION WITHIN IT6001 r) <br /> I,TANK DESCRIPTION (A staled plot plan With the location of the UST system incluQirtg buil C djaptituarksstmil <br /> lR NTALIZFD T11 ANK d t Yoa local agency,) <br /> ogenc414 <br /> a32 TANK MANU �FACT ER <br /> TANK II?# � �•,!',�k1� if•'Yes".evnthmplere ons page for sR eompluOnent. <br /> T ys YYY 7S 436 NUMBER OF COMPARTMENTS 437 <br /> DATE INSTALLED jYEARfMO) 435 TANK CAPACITY IN GALLO S <br /> br// G. 439 <br /> ADDIT ON AAL DESCRIPTION(Por local var only) <br /> lI.TAPIK CONTENTS � <br /> TANK USE 459 PETROLEUM TYPE <br /> 1.MO TOR VEHICLE FUEL 1a. REGULARUNLEADED El 2. LEADED ❑S. JET FUEL <br /> ATC _ 6.AVIATION FUEL <br /> I edcvmPleteYerroieum7yp4) Ib. PREMIUM UNLEADED ❑3.DIESEL ❑ <br /> [17.NON•FU£L PETROLEUM Q Ic. MSDOR �,OTHERADE UNLEADED ❑4. GASOHOL Q aq2 <br /> E].3.CHEMICAL PRODUCT COMMON NAME(IromHasartlo <br /> "a Materiars rnventory pstl°) Oar CAS*0Mm k(»rd0w D4"Male inventory WSe) <br /> ❑4. HAZARDOUS WASTE <br /> (lnerudes Used Oil) <br /> [_1 95.UNKNOWN <br /> III, TANK COySTRUCTION 4f <br /> TYPE OF TANK l• SINGLE WALL 3. SI\GLE WALL WITH S:S3NGL£WALL WITH INTERNAL BLArJI�ER SYSTEM <br /> EXTERIOR MEMBRANE LWER Q 95.UNKNOWN <br /> (heck one item only 4. SIGNLE WALLIN VAULT ❑49.OTHER <br /> 2. DOUBLE WALL ❑ 95.UNKNOWN s'~ <br /> TANK MATERIAL-primarywnk 1. BARE STEEL <br /> FIBERGLASS/PLASTIC 5.CONCItET£ <br /> (Check one item only) 13 2. STAINLESS STEEL a. STEEL CLAD W/FIBERGLASS ❑S.FRPCOMPTIBLE W1100%METHANOL <br /> ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) a5 <br /> TANK MATERIAL-aFcondsrymnk 1. BARSTAT LESS <br /> STEEL 3. FIBERGLASS/PLASTIC <br /> S. CONCRETE 95. UNKNOWN <br /> (Ckeck on;rremonly) L3 2. STARvLE55 STEEL Q 4. STEEL GLAD wrFIBERGLASS [It. FRP COMPTISLE W/)00%METHANOL [3 99.OTHER <br /> REINFORCED PLASTIC(FRP) CrIO.COATED STEEL <br /> ©5, CONCRETE <br /> EPDXY NING IN <br /> S•GLASS LING 93,UNKNOWN 446 DATE INSTALLED <br /> TANK INTERIOR LINING ).RUBBER LINED 447 <br /> 3 LI <br /> ❑2 ALKYD L!LINING ❑ <br /> 4 PHENOLIC LINING 0 6 UNL(NED Q"OTHER <br /> OR COATING [For lncnl uec only) <br /> (Chsckeeeiwmonly) 449 DATE INSTALLED <br /> OTHER CORROSION ©1 MA449 <br /> MANUFACTURED CATHODIC 0 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN <br /> C7 4 IMPRESSED CURRENT L)W MFRPROTECTION If APPLICABLE PROTECTION (For local use only) <br /> Ctretkoeaitanonly) ❑2 SACRIFICIAL ANODE 432 <br /> ( 431 OVERFILL pROTEC'1"10N EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL <br /> YEAR INSTALLED 430 TYPE Oocal we QA1Y) <br /> E31S <br /> k SPILL CONTAINMENT ) ALARM ❑3 FILL TUBE SHOFF VALVE <br /> (C,Wkall dw#Vply) 0 + , Q 2 BALI.FLOAT ❑4 EXEMPT <br /> L3 2 DROP TUBE U <br /> Q 3 STRIKER PLATE <br /> IV.TANK LEAKDETECTIOY(AdescrlpdonOFlhemonitorngDrogramshall, o.brmttrdmthe locela8 ') 454 <br /> 411 1P DOUBLE WALL TANK OR TANK WITH BI.ADL)ER <br /> IF SINGLE WALL TANK(CR«k all that aPvlY) (Checir w-s hem Only) <br /> VAULT ONLY) <br /> ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(INTO) M ONTIINU UAL USLE WALL INTERSTITIAL MONITORING <br /> CI 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE <br /> ❑3 CONTINUOUS ATO D 7 GROUNDWATER E33 MANUAL MONITORING <br /> ©4 STATISTICAL INVENTORY RECONCILIATION C]ii TAMC TESTING _ <br /> (SIR) g1ENNIAL TANK TESTING ©99 OTHER <br /> IV.7AIYK CIOSUIiI:I\FOR,yIATION/PERMAPZENT CLOSUn IN PLACE 45y <br /> 455 TANK PILLED WITH INERT MATERIAL? <br /> ESTIMATED DATE LAST USER(yyMOYDAY) 1>STIMATEb QUANTITY OF S(7BSTANCE REMAINING [�Ye3 © No <br /> Rallons <br /> 10 FOrinerly S%RCB Form.B <br /> UPCF(122/99 revised) <br />