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FROM JIM THORPE OIL, INC. • FAX NO. : 209 368-1851 ,0 Dec. 19I20003:02PM P6 UNIFIED PROGRAM CONSOLIDATED FORM ` I UNDERGROUND STORAGE TANKS -TANK PAGE Y TAINKS (two pug"per tank) TYPE OF ACTION ❑I NEW SITE I'ERM171 Q AMENDED PERMIT [] S CHANCE OF INFORMATION Nice—of (Check one ile,nonly) ❑ 6 TEMPORARY S1Tf CLUSURJ; ^� ❑ 7 PERMANENTLY CLOSED ON SITE RLNE WAL PERMIT (Specify rfawn-for local tA`only) (Spee BUSINESS NAS rY nehon for Iocalvae only) D R TANK REMOVED lSarx se FACILITY NAME or D8A�•Dpin(:DusineAu As) FACILfi`Y[A: �� LOCATION W X377 1 rTHIN SI (Ogionrsf) 431 I.TA1VK DIrSCRlPTION (A scaled ploy plan with t13c locution of the UST system includin buildi TAMC ID a 432 S n gs and landmarks shall be Submitted to the 1,,—iageacy,) �I TANIc MnNLFAC�TLRER 433 COMPARTMENTALfZI D TnNK Q Yes Flo a� DA TE INSTALLED(YEAR/MO) t3S TANKd41TY GALLONS 436 Ir-Yef-,aonOle-C,re pavroe eachcompann,em. /7r ... QO NUM$EIt OF C,Vm I'AF TMENTS �D ;7 _ . ._ ADDITIONAL DESCRIPTION(For local g only) TANK USEROLEUbtTYPG 439 I1_TANK CONTENTS PET Wo'l'MOTOR VEI-]ICLE FUEL ❑) REGULAR UNLEADED4Q(If-Iwked complete Pe,releum.Type) ^� ❑2. LZADED 05. JET FUEL t ❑'-, NON-FUEL PETROLEUM fpr PREMIUM UNLEADED ❑3. DIESEL [16. AVIATION FUEL ❑1C. MIDGRADF UNLEADED ❑4,GASOHOL El99.OTHER ❑ J. CHEMICAL PRODUCT COMMON NAME (from Nazq*dour Maicrials lnvcmlo ❑4. HAZARDOUS WASTE, rypogo) 441 CASIO(from IlnsAnlous Kvg, is In•emory pAge 1 442 (Inckid:Ueal(hp Cl 95.UNKNOWN III. TANKCONSTRUCTION TYPE OF TANK ❑I. SINGLE WALL 3. SINGLE WALL 1,1, I r3:1❑S. 51NGLE WALL W]Tli INTERNAL BLADDER SYSTEM 441 (Check one Gem valyl EXTERIOR MEMBRANE LINER ❑95- UNKNOWN BLf WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL pr)mary tank t. SgRE STEEL ❑3. FIt;ERGLA55/PLASTIC 5. CONCRETE ❑95. UNKNOWN 4"(e heck one u on y) ❑2. STAlNLF,55 STEEL ,..- n FEEL CLAD W/FISERGLASS ❑R. FRP cOMPTtstE w/tooei METHANOL ❑99,OnIFR REINFORCED PLASTIC(FRP) TANK MATERIAL-secongteytydr W I. BARE STEEL []3. FI RGLASS/PLASTIC ❑S. CONCRI7F ❑ns. UNKNOw�I ++s (Check one keen only) ❑2. STANLESS STEEL $TEEL CLAD W/F1B$RGLASS v ❑$• FRP COMPTIBLE W/lOp,y METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) C I0.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING I.RUBBER LINED ❑;.EPDXY LIN1NC Q 5•GLASS LINING 95.UNKNOWN 4av DnT£1NSTnLL£D J-f7 OR COATNG ❑Z ALKYD LINING ❑4 PHENOLIC LINING �� fchak one nem vnb') '�""'`QED ❑99 OTHER _ (For lows use only! OTHER CORROSION Cf I MANUFACTURED CATHODIC FIBERGLASS REINFORCED PLASTIC Q 95 uNKNOWN 4" DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT (Cheek one dem mdy) ❑2 SACRIFICIAL ANODE ❑Y9 OTHER SPILL AND OVERFILL YLARINSTALLED 450 (For local�nnly) TYPE poen)n+eonlyJ 451 OVERFILL PROTECTION EQ(IPMEVT;ygAlt],;STALLED 452 (Glnckau,rwc;mply) t�5 LCONTAINMfN7 (�/ L'J 2 OP TUBE ❑I SRM FILL TUBE SHUTOFF VALVE ❑ STRIKER PLATE 2 BALL FLOAT ❑4 EXI;MPT IV,TANK LEAD DETECTION(A dmIrolion o(thc monitnn„B pmgramshhil be submie,rd toelx Inwl a¢eney.) IF SINGLE WALL TANK(Check all flu apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 C1 t VISUAL(EXPOSED PORTION ONLY) (�5 MANUAL TANK GAUGING( ) ❑G IC 1 one item Dory) t VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMA'rlC TANK GAUGING(ATG) ❑6 VADO$E ZONE ❑2 CONTINUOUS 1NTERSTTTIAL MONITOR]NG ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION El$TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMA`IE.NT CLOSURB IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATFD QUA,NTFfY OF SUBSTANCE REMAINIYG 456 TA-14K FILLED WITH NER,r MATF,RIAL" 417 gallons ❑Yes [] No UPCF(12/99 revised) Formerly SWPCB Form B