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_ sf ., UNIFIED PROGRAM CON-SOLIOATED FOR,. DTANKSUNDERGROUND STORAGE TANKS-TANK PAGE 1 � Page _ of ❑ S.CHANGE OF INFORMATION) ❑ 8.TEMPORARY SITE CLOSURE' TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Check one item only) J'3�/ ($pacify charge-for lova!use only) ❑ 8. TANK REMOVED 430 � .RENEWAL PERMIT (Sp-Ilymason•farlacal use onlY7 f FACILITY IO ti '�s BUSINESS NAME(Same as FACILITY NAME or OBA•Doing Business As) jpowC, e- All LOCATION WITHIN SITE pticnaq 43� 1.TANK DESCRIPTION COMPARTMENTALIZED TANK Yes C3No � TANK MANUFACTURER It'Yss',complete one page for each compartment. TANK IDa /�/ S 7-E (�(„�i�- FNUMBER OF COMPARTMENTS TANK CAPACITY IN GALLONS GATE INSTA•1LLEO(Y9ARlMO) I ADDITIONAL OESC^'PT N(For local use only) I It.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 2 LEADED ❑ 5. JET FUEL ❑ta. REGULAR UNLEADED DIESEL ❑ 6. AVIATION FUEL ❑ 1 MOTOR VEHICLE FUEL ❑1C PREMIUM UNLEADED ❑99. OTHER (Il marked.complete Petroleum Type) ❑ 4. GASOHOL I ❑ 2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED CAS Is(from Hazardous Materials Inventory page) ❑ 3. CHEMICAL PRODUCT COMMON NAME(hom Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE(Includes Used Od) III.TANK CONSTRUCTION ❑ - ❑ S. SINGLE WALL WITH INTERNAL BUDDER SYSTEM 3.SINGLE WALL WITH TYPE OF TANK ❑ J. SINGLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN - 2. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT C3 99. OTHER (Check one dem only) ❑95. UNKNOWN ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑99 OTHER___ --- TANK MATERIAL•primary tank ❑ 1. BARE STEEL LO�, a'STEEL CIAO WIFIBERGLASS ❑ 8. FRP COMPATIBLE W/IC01 METHANOL . (Check one item Only) [32. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑ 8. FRP COMPATIBLE W1100%METHANOL ❑95. UNKNOWN ❑ 3. FIBERGLASS I PLASTIC TANK MATERIAL-secondary tank ❑ 1. BARE STEEL �,/ ❑99. OTHER�._._---- CR 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORR0010LE JACKET (Check one dem only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ S.CONCRETE DATE INSTALLED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑.6. UNLINED ❑99. OTHER (ForForloca OR COATING ❑ 2 ALKYD LINING ❑ 4. PHENOLIC LINING ❑95. UNKNOWN 434 DATE INSTALLED (Check one item on ) ❑ 3. FIBERGLASS REINFORCED PLASTIC OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑99.OTHER (For)o. PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT (Check am item only) ❑ 2. SACRIFICIAL ANODE TYPE(For focal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED YEAR INSTALLED SPILL AND OVERFILL 7�1.ALARM E33. FILL TUBE SHUT OFF VALVE (check an that apply) ❑ 1. SPILL CONTAINMENT�-- l❑ 2, BALL FLOAT ❑ 4. EXEMPT ❑ 2. DROP TUBE -- -' ❑ 3. STRIKER PLATE -. _ .. N.TANK LEAK DETECTION - IF DOUBLE WALL TANK OR TANK WITH BLADDER'Check om item on ): IF SINGLE WALL TANK heck all thaf a ): 5. MANUAL TANK GAUGING(M7G) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑8. VADOSE ZONE ❑ 3 MANUAL MONITORING ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ T. GROUNDWATER ❑ 3, CONTINUOUS ATG ❑ g, TANK TESTING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) 99 OTHER BIENNIAL TANK TESTING ❑ V.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE 143 LAC TANK FILLED WITH INERT MATERIALS ESTIMATED QUANTITY OF SUBSTANCE REMAINING ❑No ESTIMATED DATE LAST USED(YRnAO/DAY) gals ❑Yas Formerly SWRCB -I,o F cr)RM(4/99)