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SEP-14-2004 16:00 SRC 9259730584 P.02 .7 0 INMED PROGRAM CONSOLIDATED 1~ORivi TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages tank) page-of TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ S CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Chock orre imm o^ly) -._.� _ ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Spetily rexaon-for local use only) (Slleciry reason-Ibr total use only) [] STANK REMOVED 430 BUSINESS NAME(S, ez4l`ACILI YNAMEorDRA-.Doir)9aUieaaAa) 3 FACILITY ID: 10"1 1 ;, $I t ie/�Pc ECL 0/S Al• ,S19d old ui .S-7aa�c� 3q S 1 LOCATION WITHIN SITE(Opdonal) . 1 1 431- 1.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall he submitted to the local agency-) TANK ID#4 a7q7 432 TANK MANUFACTURER 433 COMPARTMENT"ALIZEE)TANK Yea No 434 oD /1/ I Y If"Yes',eor-1001c Gee payc for enehcompar(Ment, DATE INSTALL D(YCAR/MQ) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIPTION(Por local We only) 6 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 1.MOTOR VEHICLE FUEL 11la. REGULAR UNLEADED ❑2, LEADED ❑S. JET FUEL 440 (Irrrurked complete Pnroleym Ty ) 0 1b. PREMIUM UNLEADED .111 3, DIESEL ❑6. AVIATION FUEL [32. NON-FUEL PETROLEUM ❑le. MIDGRADE UNLEADED [14_GASOHOL 0 99.OTHER O 3. CHEMICAL PRODUCT COMMON NAME (Rom Hazardous Materials]mrcn(oy o&) 4u l CAS#(hom Nawa%,3 Materials lnvemorypage) 442 ❑4. HAZARDOUS WASTE (IMludw Used Oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL U 3. SINGLE WALL WITH 5_ SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check me ilem only) ,,. - EXTERIOR MEMBRANE LINER Q 95. UNKNOWN jd2. DOUBLE WALL 0 a. VONLE WALL IN VAULT [199. OTHER TANK MATERIAL-primaryrank i. BARB STEEL Ll 3.FIDSROLAS5/PLASTIC S. CONCRETE Lj 95. UNKNOWN 444 (Check amitern only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑9, FRP COMPTIBLE W/IW%METHANOL ❑99,OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-sewndmi tank Ll 1. BARE STEEL U 3. FIBERGLASS(PLASTIC 5. CONCRETE U 95.UNKNOWN 445 (Cheek Qw icern only) E3 2. STAINLESS STE£I, JM4• STEEL,CLAD,W/FIoERGLASS Ll 8. FRP COMPTIBLE W/100%METHANOL 099.OT)iER REINFORCED PLASTIC(FRP) 1110.COATED STEEL []5. CONCRETE TANK INTERIOR LINING 1-RUBBER LINED 3.EPDXY LINING El 5,GLASS LINING 0 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING [:12 ALKYD LINING ❑4 PHENOLIC LINING UNLINED 1:199 OTHER (Cbxk one item m1y) -- (Por total use only) OTHER CORROSION p 1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN °4' DATE INSTALLED 419 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Cbwk one item only) ❑2 SACRIFICIAL ANODE (For local me only) SPILL AND OV9PF1I.L/ YEAR INSTALLED 450 TYPE pxal wQWy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (CJntkall lhuapply) (-`'7�1SPILL CONTAINMENT 1493 Or] ALARM J?q3 ❑3FILL.TUBE SHUT OFF VALVE [ 2 DROP TUBE 11173 L{2 BALL FLOAT ❑4 EXEMPT 5i STRIKER PLATE /Q 9a IV.TANK LEAK DETECTION(A 4Mripdon of the monitoring yrogrw shall be submided ro rhe lwal agency.) IF SINGLE WALL TANK(Check all dmr,ppiy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Cask one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑S MANUAL TANK GAUGING(MTG) ❑1 VISUAL-(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) 6 VADOSE ZONE (2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATC 0 7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION (:)8 TANK TESTING (SIR) BIENNIAL TANK TESTING E199 OTHER IV.TANICCLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) °ss ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons 0 Yes 0 No UPCF(12/99 revised) 10 Fotrnerly SWRCB Form B