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FROM JIM THORPE OIL, INC. . FAX NO. : 209 368-1851 0 Dec. 19 2002 03:01PM P3 <br /> UNIFIED PROGR ICM CONSOLIDATED 1rOkM <br /> UNDERGROUND STORAGE TANKS TAINK PAGE 1 T��CS <br /> (Iwo PR996 per tank) <br /> TYPE OF ACTION 0 1 NEW SITE PERMIT 4 Pa:2_-of <br /> [] AMENDED PERMIT [] S CHANGE OF INFORMATION ❑ h TEMPORARY SITE CLOSURE <br /> (Cl,q;k one kcmonly) <br /> ❑ 7 PERMANENTLY CLOSED ON SITE <br /> 3 RENS WAL PERMIT (Specify rewp n-for lrwal useonly) (Spocify repyon-for looht use only) ❑ 8 TANK REMO VED <br /> BUSINESS I iSaM 4b FACILITY VAMP Oe DBA-point'tiusine58 As) FACI)_fTY ID; 430 <br /> -j , 3 ) <br /> LOCATION W1174N S (OW6,w) <br /> 431 <br /> I. <br /> T' DF <br /> DESCRIPTION (A scaled plot plan with the loeation of tha UST system including buildinB.a Aad landmarks shall be submitted t0 the legal agency.) <br /> TANK TD# °32 TANK MANUFACTURER 433 <br /> 04 � COMPARTMENTAL TANK Yes No ,,,,, <br /> DATE INSTALLED YEAR/MO 435 If Yes^,conmlem oft page 1Lrgachcompurtmem. <br /> /ST ( +e) TANK CAPACITY IN GALLONS 43s NUMBER OF COMPART7vIENTS 437 <br /> 7 g /4 ^^ <br /> ADDITIONAL DESCRIPTION(For luoalnseonly) <br /> IL TANK CONTENTS <br /> .✓TANK USE °S9 PETROLEUM TYPE <br /> 9.11. MOTOR VI:HICLE rUFL 4qp <br /> ❑l:u REGULAR UNLEADED 2, LEADED []S. JET FUEL <br /> dfaWkp)cumpletePutroleumTypq) ( Ib. PREMIUM UNLEADED DIESEL <br /> ❑2. NON-FUEL PFTROLPLIM 11 IC. MIDGRADE UNLEADED 0 0 AVIATION FULL <br /> ❑a. GASOHOL 99.OTHER <br /> Q 3. CHEMICAL PRODUCT COMMON NAME (from Raza doou Materials Invento <br /> 13 4. HAZARDOUS WASTE ry P4xa) 441 CAS#(from Hazardous Msenglg Inventory paiv) 442 <br /> (Includes Decd Dip <br /> ❑95.UNKNOWN <br /> III, TANK CONSTRUCTION <br /> TYPF OF TANK ❑I. SINGLE WALL-03- SINGLE WALL WITH 13 <br /> S, SINGLE WALL WITH INTERNAL BLADDrR SYSTEM 443 <br /> (Check ono am only) EXTERIORMEMBRANE LINER ❑95. UNKNOWN <br /> C)f LE WALL ❑a. SIGNLE WALL IN VAULT ❑99. OTHER <br /> TANK MATERIAL-prix awytank QrI, BARE STEEL }. PIIIEROLASS IPLASTIC <br /> S- CONCRETE 95, UNILYOwY 444 <br /> (Click oqc am only) Q 2. STAINLESS STEEL ,a rEEL CLAD W/FIBERGLASS CIS. FRP COMPTBLE W/100%METHANOL ❑99,OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL see„gl,ry tank ❑i. BARE STEEL Q 3, FI RGLASS/PLASTIC 5, CONCRFTE <br /> Q 95. UNKNOWN 445 <br /> (Check one ecmonly) ❑2. STAINLESS sTF,EL STEEL CLAD W/FIBERGLASS 08- ERP COMPTIBLE W/100%METHANOL ❑99.OTHER <br /> RENFOPM PLASTIC(FRP) 0 10,COATED STEEL <br /> 5, CONCRETE <br /> TANK INTERIOR LINING 0 L RUBBER LINED LJ 3.EPDXY LINING 5•GLASS L1NNG Ll 95.UNKNOWN us DATE INSTALLED 447 <br /> OR COATING 0 2 ALKYD LINING 0 4 PH&NOLIC UNNC UNLINED <br /> (Check one item only) ❑99 OTHER <br /> (For local we only) <br /> OTHER CORROSION ElI MANUFACTURED CATHODIC (TSEROLASS REINFORCED .�I <br /> PLASTIC 0 95 UNKNOWN 448 DATE INSTALLED ll 4°9 <br /> PROTECTION)F APDL ICABLE PROTECTION 0 It IMPRESSED CUkRFNT ❑99 OTHER <br /> (Cnp;k one hen,only) ❑2 SACRIFICIAL ANODE <br /> {For local use only) <br /> SPILL AND OVERFILL, YPNT INMENLED Oso T ypg(local only) 451 OvER>ILL PROTECTION EQUI;;FiILLTU <br /> AR INSTALLED 452 <br /> (ClsSk all tont apply) I S L CONTAINMENT OP TUBE0 1 ALARM 3E SHUT OFF VALVE <br /> Q 2 BAIL FLOAT 0 4 EXEMPT <br /> STRIKER PLATE <br /> IV,TANK LEAK DETECTION(A description ofthe nwnboring proas4m shall be submitted to apo legal agency,) <br /> IF SINGLE WALL TANK(Check on zhat apply) 451 IF DOUBLE WALL TANK OR TANK WITH BLADDER <br /> 454 <br /> (�I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) 111 VVISUAL(SING.£WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑IS VADOSE ZONE ❑2 CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3 CONTINUOUS ATG El 7 GROUNDWATER <br /> ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING [7 99 OTHER <br /> IV,TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MOIoAY) °55 PST]MATED QUANTITY OF SUlsS�ANCE REMAINING °" TANK FELLED WITH INERT MATERrnL� 457 <br /> UPCF(12/99 revised) 0 <br /> FormerIy SWRCB Folin B <br />