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ti FROM : JIM THORPE OIL, INC. FAX NO. : 209 368-1851 Dec. 19 2002 03:02PM P5 uY UN>iFrED PROGRAM CUNSOLiDATED FORT UNDERGROUND STORAGE TANKS_ TANK PAGE Y T',Nres (tt"o II nor tank) M'I':OF ACTION ❑I NrW SITr PERMIT ❑ 4 AMENDED PERMITPage at_ Q 5 CHANGE OF INFURMATIt]N e TEMPORARY SITE CLOSURE (Check nne item un1Y) ❑ ❑ 7 PERMANENTLY CLOSED ON SITE J RENEWAL PERMIT (Specify rcason-for local um only) (= BUSINESS NAt g �Poci=-7 rcaaon-for lel use o�lr) 0 8 TANK REMOVED . (Same m FACILITY NYAME or DaA-(bin Huaineea.u) FACILITY a30 61, M.'1 t iL ] LOCATION WITHIN S L(Upr+unaq J)l L TANK DESCRIPTION (A scaled plot plan With the location of the UST syste'M including buildings and landmarks shall be submitted to the local agency.) TqL ID 0 132 TANK MANUFACTURER as / 'r�Dl��D//1 lQO r COMPARTMENTALIZED TANK YL, Vo ala OATEfNSTpLLLED YEAR/fM/O +l If•• If e3,i°b"o m �r --a+*rmenr ( ) a]s TANK CAPACITY IN GALLONS 4� NUMBER of COMPARTMENTS /9qh - 90 oa f a» ADDITIONAL DESCRIPTION(Por heal use only) A.TANK CONTAIN16 ,.,�TAVKiJSE a]9 PETROLEUM TYPE L4 l MOTOR VEHICLE FUEL ❑Ia R$GULAR UNLEADED � (lrnwrked complete Pearolcum Type) ❑z- L;=ADED ©5. JET FUEL D 11: PREMIUM UNLOADED *1 1 ESEL ❑6. AVIATION FUF,L 112, NON-FUEL PETROLEUM ❑Ic. MIDGRADF UNLEAII 04, GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from HaYanioua Materials Invrntvrr ❑4. HAZARDOUS WASTII Page) 441 CAS#(from Haxordous Mater%M6Invenuary page) aaz (Inefude:Used 010 [195.UNKNOWN III, TANK CONSTRUCTION TYPr OF TANK Q 1, SINGLE WALL ❑3, SINGLE WALL WITH ❑: SINGLE WALL WITH INTERNAL I)LADUER SYSTEM Whrck one item vniy) EXTF,RIOR MEMBRANE LINER ❑95. UNKNOWN aa} BLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL_primary,,,k I. BARE STEET. [7 3. pI13ERGLASS/PLAS77C ❑5. CONCRETE 95, UNKNOWN aaa (Chttkoneilemoniy) ❑?. STrVNLP,SSSTFEL ,ti, orEF.LCLADW/FIBERGLASS ❑8. FRP COMPTIBLEW/100%METFIANOL ❑99.OTFI?;R REINFORCED PLASTIC(FRP) TANK MATERIAL-ecvvndarytank 11 LJ 3. FWRGLASS/MAS17C 5, CONCRETE (Cheek one itenvnIy) ❑2. STAINLESS STEEL (FIBERGLASS ❑8. FRPSTEEL CLAD W ❑�5- OT HEaa5 COMP7TALE W/lt)0%METIIANpL ❑Q9.. T{.{gR REINIFORCED PLASTIC(FRP) ❑10,COATL)STEEL 0 S. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING S,GLASS LINING 95.LNKVUWN aa(; llATE INSTALLED as ORlChCOooe arm only) ❑2 ALKYD LrNING ❑4 PHENOLIC LINING UNLINED ❑9v oTriEA (For local"'_vnly) OTHER COxROSION ❑1 MANUFACTURED CATHODIC a FIBERGLASS REINFORCED PLASTIC ❑95 UNICNOWN aa8 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑41MPRESSED CURRENT (0cck one item ugly) El .SACRIFICIAL ANODE. ©99 OTHER SPILL ANDOVERFILI, YEARINSTALLED 450 (For localttseonly) TYPE(Inal use only) 451 OVEP-FTLL PROTECTION FQUI;E�BE R INSTALLL'D a52 (Check all that apply) l S L CONTAINMENT ,,, I SHUT OFF VALVE LS' OP TUBE I❑ ALARM ❑STRIKER PLATE 2 BALL FLOAT ❑4 EXEMPT IV,T; NK LEAK DE'T'ECTION(A deyo,iptio„of the munitol,,pmgram%hell be>ubmitted to thu local agency., 1F'SINGLE WALI TANK(Cltm;k all thm apply) BLE WALT, TANK OR TANK WITH BLADDER aea ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGI:ZM item only) UAL(SINGLE WALL.IN VAULT ONLY) 2 AUTOMATIC,TANK GAUGCIG(ATG) ❑6 VADOSE ZONE TINUOUS INTERSTITIAL MONITORNG ❑3 CONTINUOUS ATG 0 7 GROUNDWATER NUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING 0 99 OTHER IV.TANK CLOSURE TNFOWMATION/PERMANENT CLOSURE IN PLACF ESTIMATED DATE LAST L;SF.D(YR/MO/DAY) t5' ESTIMATED QUANTITY OF SUBSTANCE REMAINING ase TANK FILLED WITH INERT MATERFAL' 457 gallons ❑YcG ❑ No U?CF(1;2199 revised) Formerly SWRCB Form B