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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (two pages per tank) Page_of TYPE OF ACTION ❑I.NEW SITE PERMIT ❑4.AMENDED PERMIT ❑5.CHANGE OF INFORMATION) ❑6.TEMPORARY SITE CLOSURE (Check one item only) ❑7. PERMANENTLY CLOSED ON SITE ❑3.RENEWALPERMIT [:18.TANKREMOVED 430 (Specify reason-for local use only) (Specify change-for local use only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 I FACILITY ID# I ConocoPhillips, Site#255886/5886 LOCATION WITHIN SITE(Optional) 431 I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ® No 434 2 TO oft If I1 Yes0,complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1995 15,000 0 ADDITIONAL DESCRIPTION(For local use only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑ 2. LEADED ❑ S.JET FUEL (Ifmarked,complete Petroleum Type) ®Ib. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑]c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER_ ❑3.CHEMICAL PRODUCT ❑ 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Inventorypage) "I CAS#(from Hazardous Materials Inventorypage) 442 Used Oil) ❑95. XERXES M.TANK CONSTRUCTION TYPE OF TANK Eli.SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER E:195. XERXES (Check one item only) ❑ 4. SINGLE WALL IN A VAULT [:199.OTHER TANK MATERIAL-primary tank ®l.BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. XERXES 444 (Check one item only) ❑2.STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER REINFORCED PLASTIC RP TANK MATERIAL-secondary tank ❑1.BARE STEEL [13, FIBERGLASS/PLASTIC ❑8. FRP COMPATIBLE W/100%METHANOL ❑95. XERXES 445 (Check one item only) ❑2. STAINLESS STEEL ®4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑3. EPDXY LINING ❑5.GLASS LINING ❑95. XERXES 446 DATE INSTALLED 447 OR COATING ❑2.ALKYD LINING ❑4. PHENOLIC LINING ®6.UNLINED ❑99.OTHER Check one item only) or local use only) OTHER CORROSION ❑I.MANUFACTURED ®3.FIBERGLASS REINFORCED PLASTIC 095. XERXES 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC ❑4.IMPRESSED CURRENT ❑99.OTHER PROTECTION (Check one item only) ❑2, SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(For local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) 01. SPILL CONTAINMENT 2002 [11.ALARM 03.FILL TUBE SHUT OFF VALVE 1996 02. DROPTUBE 1996 ❑2. BALL FLOAT ❑4. EXEMPT ®3. STRIKER PLATE 1995 IV. TANK LEAK DETECTION(4 description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 F-11, VISUAL(EXPOSED PORTION ONLY) ❑5. MANUAL TANK GAUGING(MTG) ❑1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6. VADOSE ZONE 02. CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUSATG ❑7. GROUNDWATER ❑3. MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑8. TANKTESTING BIENNIAL TANK TESTING E199. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑No UPCF(1/99 revised) Formerly SWRCB Form B