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FROM JIM THORPE OIL, INC. • FAX NO. : 209 368-1851 Dec. 19 2002 03:02PM P4 MINIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS,TANK PAGE 2 TANKS (two pages pot lank) TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT pip—Of— ❑ S CHANGE OP IIfFORMATION [] 6 TEMPORARY SITE CLOSURE. (Check onr uep,only) We, 11NEW PERMIT y ❑ 7 PERMANENTLY CLOSED ON SITE (SpeciT Mawn-for local ore only) ($miry,trnon for local uce only) ❑ 8 TANK REMOVED BUSINESS N (Same as FACILITY NAME o1 DBA- 430 ODATF I?oiag 0s5iaewAsl FACILITTION WITHIN S (optiomtn� 431 TANK DESCRIPTION (A scaled plot plu7ofthe UST system iluding buildingsand landmarks shall be submitted ro rhe local ag"Cy.) ID# 432 TANK MANUFACTURER .03Q��Q COMPARTMENT ALIZED TANK ❑Y Nc 434 OO • — If"Yes",complre one Phvw for each rompsrrmem. INSTALLED(YEAR/MO) 433 TANK CAPACITY IN GALLONS 436 / .� 9c NUMBER OF COMPARTMENTS 4y7 /o dace ADDITIONAL DESCRIPTION(Por local use only) .... _„ 438 I1,TANK CONTENTS TANK USE 439 P�$T�R/ULEUM TYPE Ir MOTOR Wr;VEHICLE FUEL RbGULAR UNLEADED 40O ❑2. LEADED 0 S. SET FUEL C](Ir2. ed NON-FompleteUEL Ptmi�PETROLEUM type) C]I b, PRL•MMW UNLEADED []3. DIESEL ❑-. NON-FUEL PETROLEUM ❑e• AVIATION FUEL CI IQ MIDGRADE UNLEADED ❑4, GASOHOL 99.OTHER 0 3. CHEMIcnt.PRODUCT COMMON NAME (from Haaaruous Mauriale Inventory page) CAS#(from)1anrdous M;rtcrials Inumlory page 1 442 ❑4. HAZARDOUS WASTE (frelAct Used Din 0 95,UNKNOWN III, TANK CONSTRUCTION TYPE OfANK Q 1. SINGLE WALL 3, SINGLE WALL WITH 5. SINGLE WALL WITH INTER.NAI,BLADDER SYSTEM 443 (t-'heek gnEXTERIOR MEMBRANE LINER 0 95. UNKNOWN 21�- 6LE WALL ❑4. SIONLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-mmarytaea 1. BARB STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. LWK;11WN 44a Wha;k one hew"only) 02. STAINLESS STEEL ,FEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL 0 99,OTHER REINFORCED PLASTIC(FRP) YA'IKMArERIAL• ecoMnrytank ❑1. BARE STEEL �,,3�. M RGLASS/PLASTIC (Chick one item only) ❑2. STAINLESS STEEL O STEEL CLAD W/FIBERCLASS ©5. CONCRETE. 95. .OTHE WN 400 r38, FRP COMPTIBLE W/100° MF,TFIA,�UL ❑99.OT}IEA REIIJFORCED PLASTIC(FRP) ❑Io.COATED STF,EL ❑5. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED Q 3.EPDXY LINING �)�_5 0LASS LINING 95.UNKNOWN +46 DATE INSTALLED 447 OR COATMO El ALKYD LINING ❑4 PHENOLIC LINING ID'S UNLINED (check one,ren,only) ❑99 OTHER (For local use only) OTHER CORROSION Q 1 MANUFACTURED CATHODIC FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN t18 DATEINSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (G1wck oat atm Only) 0 2 SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450 '(Fork,caluuonly) � TYPE Iloc41 ax only) 451 OVERFILL PROTECTION EQUIPM£NT:Y AR INSTALLED 452 (Check all that apple ,LR I S L CONTAINM>;NT (�' OP TUBE ❑1 ALARM FILL TUBE SHUT OFF VALVE ❑2 BALL FLOAT Q 4 EXEMPT STRIKER PLATE IV.TANK LE,\K DETECTION(A descriptw orthe monhMing program shall be submitted to the 10"I agenev) IF SINGLE WALL TANI((Check all tlut a91)ly) 453 IF DOUBLE WALL TANI(OR TANK WITH BLADDER as4 ❑I VISUAL(EXPOSED PORTION ONLY) IChc1 VIS item only) []5 MANUAL TANK GAUGING(MTG) ❑I 15unL(SING-LE WALL 1N VAULT ONLY) Q 2 AUTOMATIC TANK GAUGING(ATG) 0 6 VADOSE ZONE ❑2 CONTINUOUS INTERSTITIAL MONITORI,iG ❑3 CONTINUOUS ATG ❑7 GROUNDWATER I]3 MANUAL MONITORING ❑4 STATISTICAI,INVENTORY RECONCILIATION 0 8 TANK TESTNC (SIR) BIENNIAL TANK TESTING 1:199 OAR IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE INK CE ESTIMATED DATE:LAST USED(YR/MO/DAY) 455 EsnMATED QUANTITY OF SUBSTANCE REMAINING 056 TANK FILLED WITH INERT—MATERIAL? 437 gallons ❑Ync ❑ No UPCF(12/99 revised) Formerly SWR(;B Form B