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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS —TANK PAGE I <br /> (two frank) <br /> TYPE OP ACTION ❑t NFW SITE PERMIT C] 4 AMENDED PERMIT A5 CHANGE OF INFORMATION 0 6 TEMPORARY SITE CLOSURE <br /> (Ci+•ek au lmm onty) —.__..__ —. _- 0 7 PERMANENTLY CLOSED ON SITE <br /> 3 RENEWAL PERMIT (SpecifyMwon-en,low%wooly) (Sporiryreeson--faloeal+eeonly) Q S TANKREMOVED 430 <br /> BUSINESS NAl` L(S..FAC1UTYT,1AMEorD8 -Doi-YBusinem Am) PACILI'TY ID: I <br /> atl?L I;, /h)�I f f 3 F 1 Q <br /> LOCATION WITHIN SITE(Opd w) 431 <br /> 1875.6 C0Vd*C.t-C 1vD : Ar 11r^-1 � <br /> I.TANK DESCR>XTION (A scaled pl t plan with the loa tion of the T systetil iAcluding buildings and landmarks sball be submitmd w the local agacy,) <br /> TANK ID# (/� �7 432 TANK MANUFACTURER 433 COMPARTMENTALIZED T Yea No 434 <br /> w <br /> arp / O L complete one pyla for each%niftamn _^^N--^-^Y-- <br /> DATE INSTALLED(YEARI MIO) 435 TANTS CAPACI-t'Y IN GALLONS 436 NUMBER OF COMFARTMENrS 07 <br /> 7 f Y9 3 �q�� <br /> ADDSTIO AL DESCRIPTION(r.low%m.only) J 438 <br /> I'I,TA14X CON'I'ZN'rS <br /> TANK USF, 439 ItYrT90L)XM TYPE. 440 <br /> ]. MOTOR VEHICLE FUEL ❑In. REGULAR UNLEADED Q 2. LEADED ❑5, JET FUEL <br /> t nwicede mpietePeaolcwn7ypn) {b, PREMITIM UNLEADED 0 3. DIESEL ❑6. AVIATION FUEL <br /> ! (�2. NON4UEL PE'EXOLeUM ❑1a. MIDGRADE UNLEADED ❑4. GASOHOL ❑99,O'T'HER <br /> ❑3. CHEMICAL PRODUCECOMMON NAME(from 8talardo0"Siisenals Inventarypage) 441 CAS((Mvm Hw-4nns mmmAu mveniory loge) "2 <br /> (wj 4. MkZARDOUS WASTE <br /> (W+ "dos Vsrd oil) n s� <br /> ❑9.5.UNK-TOWN <br /> 111. TANK CONSTRUCTION <br /> F TYPE OF TANK t_ SINGLE wALL NOLZ wALL WrIN 5. SINGLB,WALL.WITH RVTE VAL BLADDER SYSTEM 443 <br /> (O.;;k mvitem only) EYTERIORMEMBRANELINER ❑99, UNVNOWN <br /> DOUBLa WAIL 0 4. iIrNI.F WALL.IN VAULT ❑99. OTHER <br /> LL(IrAl""K" 4ATERIAL-primary sank U I. BARE:STEEL 3. 1,IBERGL,Q%S/PLASTTC 7. CONCAir'1'E 95. UNIKNOWN 444e iwnomy) '0:, STAINL"cSS 5'•EEL '.�,]�F. STGEL CLAD W/FIBERGLASS G"d. PRP COMPTIBLE W/100%METHANOL 0 99.071'HER <br /> REINFORCED PLASTIC(PRP) <br /> ;ANK1fATER]Af -sr�ondtr:4nk M i. SARESTEEL 3. FIBERGLASSTPLASTIC S. CONC�iLTc y. UN1C 70WN 443 <br /> (Check one itemonly) Z, STAINLESS S'IEL•L 0 4. STEEL CLAD WMBERGLASS ❑S. FRP COMPTIBLE wit00%o Mk-rKANQL 99.OTHER <br /> RE1NF'ORCEO PLASTIC(FRP) ❑10,COATED STEEL <br /> ❑5. CONCAETR <br /> TANK INTERIOR LJNING 1.RUBBER LINED 3.EPDXY LINING GLASS LINING 95.UM(NUWN 4% DA'T'E INSTALLED 441 <br /> OR COATING Q 2 ALKYD LINING ©4 PHENOLIC LINING 0 6 UNLINED 99 OTHER _...____..._.... <br /> (Check one isam only) <br /> (Icor local vee only) <br /> OTFXER CORROSION D'1 MANUFACTURED CATHODIC e�IC3 FISERGLASS REINFORCED PLASTIC 0 95 UNKNOWN ' DATE INSTALLED 445 <br /> PROTECTION IP APPLICABLE PROTECTION ❑4 IMPUSSED CURRENT ©99 OTHER _ <br /> (Check nne irem only) ❑2 SACRJi-1c AL ANODE (Por local un only) <br /> SPILL AND OVERFILL YEAR INSTALLED 1511 430 'l'YPr:po�+lweoniy) 451 OVERFILL PROTECTIONEQUIPMENT!YEAR INSTALLED j i 7 452 <br /> ((heck dl0raaaTyy) /\SPILL CONTAINMENT I ALARM Q 3 PILL TUDE SHUT OFP VALVE <br /> D 2 DROP TUBE BALL FLOAT p 4 EXEMPT <br /> ❑3 STW KIER PLATE <br /> rV_TANK I.E.AK DE'I'ECTXON(A dercoi0on of the monitating Program ahail be pJm ted to the local apney,) <br /> IF SINGLF,WALL'TANK(Check all thin apply) 433 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> ((�� oea+tam aur) <br /> ❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TAMC GAUGING(MTG) ❑I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> 0 2 AUTOMATIC TANK QAVQING(ATG) 110 VADOSE ZONE 2 CONTINUOUS INTERSTITIAL MONITORING <br /> C]3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL.MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIA'riON ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING O 99 OTHER <br /> IV.'rANIS CLOSURE INFORMIATION/PERMAN-ENT CLOSUktt IN PX„A,CIt <br /> E871MATE D(SATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTI'T'Y OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERL M 457 <br /> gallons 0 Yes 0 No <br /> UPCF(12/99 revised) 10 Formerly SWRCB Form B <br />