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UNIFIED PROGRAM C0149OLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (ttw pages per tank) Page_of_ TYPE OF ACTION ❑1. NEW SITE PERMIT C]4. AMENDED PERMIT ®5. CHANGE OF INFORMATION) ❑6. TEMPORARY SITE CLOSURE (Check one item only) ❑7. PERMANENTLY CLOSED ON SITE ❑3. RENEWAL PERMIT [18. TANKREMOVED 430 (Specify reason-for local use only) (Specify change-for focal use only) BUSINESS NAME(Sank as FACILITY NAME or 9BA-Doing Business As) 3 1 FACILITY ID# 1 ConocoPhillips# 5 `7 ,30 °17 LOCATION WITHIN SITE(Optional) 431 4 I.TANK RIPTION (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 E] Yes No 434 At D6k/L) /4®C•6 / if OYmO,complete one page for each co art ent. DATE INST YEAR/MO) 435 TANK CAPACITY IN GALLONS V l.. 436 NUMBER OF COMPARTMENTS 437 (L- 000 f ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439PETROLEUM TYPE 440 A1. MOTOR VEHICLE FUEL la REGULAR UNLEADED ❑ 2. LEADED [:15. JET FUEL If arked•complete Petroleum Type) ❑Ib. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑ 4. GASOHOL [:199, OTHER ❑3. CHEMICAL PRODUCT ❑ 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 Used Oil) ❑95. XERXES III.TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. XERXES ❑ 4. SINGLE WALL IN A VAULT ®99. OTHER TANK MATERIAL-pnnwy tank . BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. XERXES 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLADW/FIBERGLASS 08. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER REINFORCED PLASTIC FRP TANK MATERIAL.-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC [:]g. FRP COMPATIBLE W/100%METHANOL ❑95. XERXES 445 (Check one item only) [:12. STAINLESS STEEL 4. STEEL CLAD W/FiBERGLASS [:]9. FRP NON-CORRODIBLE JACKET C:199, OTHER REINFORCED PLASTIC(FRP) []10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LAZED ❑3. EPDXY LINING ❑5. GLASS LINING ❑95. XERXES 446 DATE INSTALLED 447 OR COATING 02 ALKYD LINING ❑4. PHENOLIC LINING6. UNLINED ❑99. OTHER (Check one item only) For local use only) OTHER CORROSION ❑1. MANUFACTURED FIBERGLASS REINFORCED PLASTIC ❑95. XERXES 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC . 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 0 ERFI L PROTECTION EQUIPMENT:YEAR INSTALLED r 452 1. DROLCONTAINMENT 01.P TUBE [12. BAALARM AT ❑4 FILL TUBE SHUT OFF VALVE (Check all that apply) EXEMPT STRIKER PLATE IV. TANK LEAK DETECTION (A description of rhe 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 ❑1, VISUAL(EXPOSED PORTION ONLY) ❑5. MANUAL TANK GAUGING(MTG) VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6. VADOSE ZONE CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑7. GROUNDWATER ❑3. MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑8. TANKTESTING BIENNIAL TANK TESTING ❑99. 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 El Yes ❑No UPCF(1/99 revised) Formerly SWRCB Form B