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UNIFIED PROGRAM CONSOLIDATED FORM
<br /> 4
<br /> TANKS
<br /> UNDERGROUND STORAGE TANKS - TANK PAGE I
<br /> (two pages per tank)
<br /> Page—of
<br /> TYPE OF ACTION 0 NEW SITE PERMIT ® 4 AMENDED PERMIT [1 5 CHANGE OF INFORMATION [1 6 TEMPORARY SITE CLOSURE
<br /> (Chec�,,)re^err,on v) C2 7 PERMANENTLY CLOSED ON SITE
<br /> ❑ 3 RENE'V\JAL PERMIT fcr,cc_aIjsecniy) (Speclfy reason-lor localose oniv) TANK REMOVED 430
<br /> 7_7
<br /> FACILITY
<br /> BUSINESS NArvlE-,iSa�neasFACILIrYt,AtAf-,jt DBA-Doing Hus,nestAs,_
<br /> NELLA Oil Company 427
<br /> LOCATION'v'.,''FHIN SITE;Cpt,ora'� 431
<br /> Underground Storage Tanks south of building
<br /> 1.TANK DESCRIPTION (A scaled plot planwith iI location of the UST ystem including buildings and landmarks shall be submift6d to the locate -
<br /> agency.)
<br /> 'fgqK MANUFA(Cl URER _433-7COMPARTMENTALIZED RK Yes E No 434
<br /> 42703 unknown 1 Ir Yes'.complete one page for earn compartment
<br /> DATE INSTAL..E D ;YEAR/MO) 4:35 TTANK i,APACIT, IN GALLONS NUMBER OF comPAR,rMENTS 437
<br /> unknown 12000
<br /> ADDITIONAL 438
<br /> II.TANK CONTENTS
<br /> TANK USE 440
<br /> 1 MOTOR VEHICLE FUEL la REGULAR UNLEADED C:,2 LHADED ❑5 LET FUEL
<br /> (it marl"ec"C'nolle pet:cleurr Type ❑ lb PREMIUM UNLEADED 9 3 DIESEL ❑6 AVIATION FUEL
<br /> Vk 02 NON-FUEL. PETROLEUM Clic MiDGRADELINLEADF[D f_7 4 GASOHOL C3 99 OTHER
<br /> IT Q T CHEMICAL PRODUCT442
<br /> COMMON NAME (fIr,),�iazjrjo,s rviaer,ais(rivericry page) 441 (from Fiazarcic.,s Materials inventory page)
<br /> C3 4 HAZARDOUS VVASTE Diesel #2 1 68476-34-6
<br /> 95 UNKNCVJN
<br /> 7--
<br /> Ill. TANK CONSTRUCTION
<br /> TH INTERNA,BLADDER SYSTEM
<br /> 0 INC,�E VA L- "WITH [15SINGLE WALL VVI. 443
<br /> Checaone EXTERiORIMWBRANE LINER [I 96. UNKNOWN
<br /> 2 DOU131 F*ALL 0 4 SGNLE 0AL-IN IvAlUl T [I 99. OTHER
<br /> F_STEEL 3 FIBERGLASS i 0 95 UNKNOWN
<br /> C 99 OTHER
<br /> :Check ora S-AINLESS STEEL Z -' t, EEL CL�\D'Ofil'SERGLASS ❑[3 8. FRP COMPATIBLE w
<br /> L!',j F C,R('ED�'L A 3 T'C F R P) '001/,ME;HA NOL
<br /> on_ �Pj,FiSFNGLASS 99 OTHER
<br /> 5. C.'14CREJE 0 05. UNKNOWN
<br /> TANK N,A,E R tan, f❑ - BARE STEEL. F1.-.ER6LASS P�_ASi.ic 0
<br /> 2 STAINLESS SrEFL S 7E Ei,C,I-A fj 8 FRP CONIPA718LF
<br /> REINFORCED PLASTIC(FRP} VV.1,1;0%MET HANOL
<br /> ---',)NCRE7F 71 10 COATED STEEL
<br /> TANK INTERIO��_'NTNG Ej 1 RU06F R',INED [13,EPDXY LINING 5 (AA�5S LINING C1 C-5.UNKNOWN 446 DATE INSTALLED 7
<br /> OR COMING ❑2 AILKY0 LINING 0 4 PHENOLIC L' NLINED C]99 OTHER I
<br /> Eoc local Use only)
<br /> 44$----DATE INSTALLED 449
<br /> OTHER CQRk() .)N 1 IVANUF.�,CTURFP CATHODIC IZ 3 1,BC,PGLSS RE:NIOR',�ED P1 AS I lC C]95,JNKNO',(VN
<br /> _�
<br /> PROTECTION IF A'P-L r-ABLE P R(')T F C 7!0 N 0 4 IMPRES�,E D CURRENT Ej 99 OTHER
<br /> If
<br /> (Chea one cern Only) -12 SACRIFICIAL ANODE fFor local use only)
<br /> T _ � U __ - E -;1r TYPE'local Doli 51 -b- 452
<br /> LAN6UJL YEAR jNsrALL5 � OVERFILL PROTECTION EQUIPMENTENTYEAR INSTALLED
<br /> (Chea,all SPILL CONT A'INMENT
<br /> that appl�i 1 ALARM E 3 FILL TUBE SHUT OFF VALVE
<br /> IZ 2 DROP TUBE C3 2 BALL!":_OAT 0 4 EXEMPT
<br /> 3 STRXER-LATE
<br /> 7- ON A ces,i Pt or,of kne monitoring pmgr„m shall be suhmitted to the local agency.) 7777777
<br /> IF SINGLE WALL�TANK 153 IF DOUBLE 1,,VALL TANK OR TANK WITH BLADDER 454
<br /> ,Check one tern only)
<br /> 1 VISUAL(EXPOSED PORTION ONLY) C]5 MANUAL TANK GAJG?NG(MTG) El 1 VISUAL(SINGLE WALL IN VAULT ONLY)
<br /> ❑ SE
<br /> 2 AUTOMATIC TANK GAUGING(ATG; C16 VADC_) ZONE 10 2 CONTINUOUS INTERSTITIAL MONITORING
<br /> I L-1 3 CONTNUOiF ATC; C]7 GPOUND61VATER [3 3 MANUAL MONITORING
<br /> F1 4 STA7S7'j:,-L;L 11,VENTORYRF.C'ONCILIA7 ION (:6 TANI,,TESTING
<br /> +
<br /> r90
<br /> C�LdSLJFFFIMATiON 'PERMANENT CLOSURE IN PLACE
<br /> 456 TANK FILLED',POTH INERT(MATERIAL? 45y I
<br /> RE.VAININ;_',
<br /> Yes No
<br /> gallons
<br />
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