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UNIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> t / <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 1 (t oP y sp�tank, <br /> Page - o1 _ <br /> ❑ 5.CHANGE OF INFORMATION) [38. TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION <br /> ❑1.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 7. PERMANENTLY CLOSED ON SITE <br /> (Check one item only) (Spaptlr cAange-tor local use only) ❑ 8. TANK REMOVED 430 <br /> ❑3.RENEWAL PERMIT (SpecAyreason-lorlocaluseonly) � <br /> FACILITY 10 a <br /> BUSINESS NAME(Same as FACILITY NAME of OBA-Doing Business As) <br /> G yle / 431 <br /> LOCATION WITHIN SITE(OPdonan <br /> 1.TANK DESCRIPTIONCOMPARTMENTALIZED TANK yes ❑ No <br /> TANK MANUFACTURER <br /> It'Yas',complete one page for eaU+compartment. <br /> TANK 100 &L e <br /> NUMBER OF COMPARTMENTS <br /> TANK CAPACITY IN GALLONS <br /> DATE INS <br /> `(T/ALLEDD CfEARIMO) <br /> ADDITIONAL OESCRI TION(Forlocal use only) <br /> It.TANK CONTENTS <br /> TANK USE <br /> 432 PETROLEUM TYPE ❑ 2 LEADED ❑ 5. JET FUEL <br /> M"I' 1a. REGULAR UNLEADED ❑ 6. AVIATION FUEL <br /> !�1 MOTOR VEHICLE FUEL ❑ 3. DIESEL <br /> (It marked.compote Petroleum Type) ❑tp, PREMIUM UNLEADED - ❑ 4.GASOHOL ❑99. OTHER <br /> ❑ 2. NON-FUEL PETROLEUM ❑1c MIOGRADE UNLEADED CASK(from Hazardous Materials Inwntorypage) <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME(trom Hazardous Materials lnv*ntory Page) <br /> ❑ 4 HAZARDOUS <br /> US WASTE("'dudes <br /> Used O <br /> III.TANK CONSTRUCTION <br /> ❑ 3.SINGLE WALL W17H ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> TYPE OF TANK 11. SINGLE WALL EXTERIOR MEMBRANE LINER ❑95, UNKNOWN <br /> (Chock one item only) t�2. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT ❑gg, OTHER <br /> ❑95. UNKNOWN i <br /> ❑ 3. FIBERGLASSIPIASTIC ❑ 5. CONCRETE 099. OTHER_--- <br /> TANK MATERIAL-primary tank ❑ 1. BARE STEEL ❑ 8. FRP COMPATIBLE WILCO%METHANOL <br /> 2. STAINLESS STEEL _STEEL CLAD WIFIBERGL aP5 <br /> (Check one item only) ❑ REINFORCED PLASTIC( ❑95. UNKNOWN <br /> ❑ 3.FIBERGLASS I PLASTIC ❑ 8. FRP COMPA710LE W7100%METHANOL ❑99 OTHER_--- <br /> TANK MATERIAL•secondary tank ❑ 1, BARE STEEL _,.,/ ❑ 9. FRP NON-CORROOIBLE JACKET <br /> ❑ 2. STAINLESS STEEL I!5 4 STEEL CLAO WIFIBERGLASS <br /> (Check one item only) REINFORCED PLASTIC(FRP) ❑10 COATED STEEL <br /> ❑ 5.CONCRETE OATEINSTALLEO <br /> ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOW`ta33 <br /> TANK INTERIOR LINING ❑ 1, RUBBER LINED ❑ 6 UNLINED ❑99. OTHER�- (For local <br /> OR COATING ❑ 2 ALKYD LINING ❑ 4. PHENOLIC LINING PATE INSTALLED <br /> 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 <br /> (Check one item on (For local OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑99. OTHER�--- ! <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT <br /> (Check one item onM ❑ 2. SACRIFICIAL ANODE TYPE(For local use orw OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED �la -•- <br /> YEAR INSTALLED 7 <br /> SPILL AND OVERFILL G�rlALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> (Check as that apply) ❑ 1. SPILL CONTAINMENT C1 2. <br /> 4. EXEMPT <br /> 2. BALL FLOAT <br /> ❑ 2. DROP TUBE ---- -- . <br /> ❑ 3. STRIKER PLATE :. <br /> {V.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER'CAeek one item on )� <br /> IF SINGLE WALL TANK heck e9 that 1a k ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) . <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG1 <br /> CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 6. VADOSE ZONE ® 3. MANUAL MONITORING <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ T GROUNDWATER <br /> ❑ 3. CONTINUOUS ATG <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 6. TANK TESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE 14 SLAC TANK FILLED WITH INERT MATERIAL? <br /> AY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING ❑No <br /> ESTIMATED DATE UST USED CYR/MOIOgallons ❑Yes <br /> Formerly SWRCB F <br /> CUPAFORM(4199) <br />