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D PROGRAM CONSOLIDATED F <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE I <br /> (Two pages per tank) <br /> Page 1 of 2(removal) <br /> TYPE OF ACTION [1 1.NEW PERMIT 0 4 AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION El 6 TEMPORARY TANK CLOSURE 430. <br /> (Check one item only) ❑ 3.RENEWAL PERMIT 0 7.PERMANENTLY CLOSED ON SITE <br /> (specify (Specify-n) 8.TANK REMOVED <br /> BUSINESS NAME(Sam ssFACILITYNAME orl)RA-DoingBusinessAs) 3. FACILITY ID 1. <br /> .... ....... <br /> ..... ....... <br /> Pacific Bell ........ <br /> LOCATION WITHIN SITE(Optional) 431. <br /> ........................ <br /> ....................... <br /> ............... ............... ...*"".,.,.*" ,.",., ,*.,.".,.'',,.*.,..,..,.,..,..,..", ................... <br /> ............................ . .. ..... <br /> ................................ ..... ..................... ......... <br /> ................................ <br /> . .............. .............. <br /> ... ................................... <br /> ..T <br /> .. . ... ........I I w .... . <br /> .......................... <br /> ......... ........ .......... ...... ...... <br /> ... .............. ............................... <br /> ..... .......... ....... ...... <br /> ....... . .. . .... .... .................. <br /> .... . ............ ..... .................... <br /> ...... U-4 <br /> .............. ...... <br /> fi6ill wo 1. <br /> ic <br /> . ................................... <br /> . ...... R- ...100 <br /> ow <br /> .............. ... .... . ....... <br /> TANK ID# 432. TANK MANUFACTURER 433- COMPARTMENTALIZED TANK ❑Yes No 434. <br /> 1103 Modem Welding If-Yes,"complete one page for each compartment <br /> DATE INSTALLED 435- TANK CAPACITY IN GALLONS 436- NUMBER OF COMPARTMENTS 437. <br /> (YEAR/MO) <br /> 1995 2,000 1 <br /> ADDITIONAL DESCRIPTION(For local use only) 438. <br /> .................... .... ............ .........�­­.­oo�.o.­o.�........ .......... ............................ <br /> .................................................................�A....... .............................................. <br /> ..................... ....... .... .... .. .-.... <br /> ............................... <br /> ............................ <br /> ................ <br /> .......... ............ ................... . .... <br /> M............. <br /> .................... ........ <br /> .................................................................... ..TAME ........ .......... .. ... . ................ . ... . .......... ........... <br /> ..... .... ........... ............... ........ ................... <br /> .. ............. ..................�­......................_­.'.............. .................................... ........................................ . <br /> ..... .. .......... . . . . ... ..................... ......................... <br /> ................ <br /> TANK USE 439- PETROLEUM TYPE 440. <br /> 0 1. MOTOR VEHICLE FUEL ❑Ia. REGULARUNLEADED 0 2. LEADED 0 5. JET FUEL <br /> (if checked,complete petroleum Type) ❑lb. PREMIUM UNLEADED 0 3. DIESEL 0 6. AVIATION GAS <br /> 0 2. NON-FUEL PETROLEUM ❑lc. mlDGRADEUNLEADED 0 4. GASOHOL [199.OTHER: <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials hwentorypqe) 441. CAS#(from Hazardous materials inventory page) 442. <br /> ❑ 4 HAZARDOUS WASTE <br /> (includes Used Oil) <br /> 0 95.UNKNOWN <br /> .......... ...... .... .... ................ ........................ .............................. ...... . ..... ........................... <br /> ............. . . ................................. ...... ....... <br /> . . .......... ............ ............... ............ .... <br /> ::;:.;::443.':......... <br /> ...................... <br /> ................................ .................................. <br /> . . ....................... ..... ........... ......... <br /> ...... ...................................... <br /> ............-.1............................................................... <br /> An Umic.o <br /> -­-"�........... ......�:..........I......................... ................ <br /> .......... ......... <br /> ::::1. <br /> . . . ..... ..... ........ ......................................................................... ...... <br /> . . ........ <br /> TYPE OF TANK 0 1. SINGLE WALL 0 3. SINGLE WALL WITH EXTERIOR 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Check one item only) MEMBRANE LINER 0 95. UNKNOWN <br /> 0 2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT Q 99. OTHER <br /> TANK MATERIAL-primary tank N 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC Ll 5. CONCRETE [3 95.UNKNOWN 444. <br /> (Check one item only) ❑2. STAINLESS STEEL 0 4. STEEL CLAD WNIBERGLASS 0 S. FRP COMPATIBLE 13 99.OTHER: <br /> REINFORCED PLASTIC W/100%METHANOL <br /> TANK MATERIAL-secondary tank 1. BARE STEEL U 3. FIBERGLASS/PLASTIC 0 8. FRP COMPTIBLE W/100%METHANOL D 95.UNKNOWN 445. <br /> (Check one item only) ❑2. STAINLESS STEEL N 4. STEEL CLAD WIFIBERGLASS [3 9. FRP NON-coRRODABLE jAcKET El 99.OTHER <br /> REINFORCED PLASTIC(FRP) 0 10. COATED STEEL <br /> [1-5. CONCRETE <br /> TANK INTERIOR LINING I.RUBBER LINED [13.EPDXY LINING 5.GLASS LINING 0 95.UNKNOWN 446. DATE INSTALLED 447. <br /> OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING 0 6.UNLINED 0 99.OTHER 1988 <br /> (Check one item only) <br /> OTHER CORROSION 0 1.MANUFACTURED CATHODIC 0 3.FIBERGLASS REINFORCED PLASTIC 19 95.UNKNOWN 448. DATE INSTALLED 449. <br /> PROTECTION PROTECTION [:14.R,4PRESSED CURRENT [3 99.OTHER - 1988 <br /> (If Applicable) 0 2.SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. <br /> (Check all that apply) 1.SPILL CONTAINMENT _1995 N 1.ALARM (1995) N 3.FILL TUBE SHUT OFF VALVE <br /> 2.DROP TUBE -190- 0 2.BALL FLOAT(1995) 0 4.EXEMPT <br /> 3.STRIKER PLATE 1995 <br /> .. .............. ..... .. ......... .......... <br /> ..............%..... <br /> ....... ..... .. .. .................................... ......... <br /> -- *.. ...: .. ............................ .. ... ....................... .. <br /> .............. ....:--- <br /> .......... ...........I...................... ..................................... ....... .... <br /> .. ... .... ................... ....... ............... ...... <br /> ................ .. ........ ... .. ...... <br /> . ..... .%:...'..".. <br /> .': ..... ... .... <br /> ............ €�iri toe . ..... <br /> ................ ...... <br /> ....................... <br /> ................ ...... A&....... <br /> ............ <br /> ............ <br /> .......... <br /> ...... .... <br /> . ... ... <br /> ....... .. <br /> ............... <br /> ...... .. ... 4w <br /> IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. <br /> (Check all that apply) (Check one item only) <br /> ❑1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(IvfrG) [11.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2.AUTOMATIC TANK GAUGING(ATG) 0 6.VADOSE ZONE 2.CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3. CONTINUOUS ATG El 7.GROUNDWATER ❑3.MANUAL MONITORING <br /> 0 4 STATISTICAL INVENTORY RECONCILIATION 0 8.TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING 0 99. OTHER <br /> .............................. ...... <br /> --------------wl...........­.......­........ ................ <br /> .. ........ ...... .............. <br /> ..................................... v <br /> .......... ..... <br /> ........... <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTRvFATED QUANTITY 0FSUBSTANCF <br /> ,REMAR41NG 06. TANK FILLED WITH INERT MATERIAL? 457. <br /> Currentlyactive gallons ❑Yes 0 No <br /> UPCF hwfwrc-b(1/99)-1/4 hftp://www.unidoes.org Rev.02/16/00 <br />