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IFIED PROGRAM CONSOLIDATED FOW k1 /N 7 <br /><< TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br />(two pages per tank) <br />Page -of <br />TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ® 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br />(Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE <br />❑ 3 RENEWAL PERMIT (Specify reason -for local use only) (Specify reason -for local use only) ❑ 8 TANK REMOVED 430 <br />BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) <br />FACILITY ID: <br />TTT <br />1 <br />Tesoro West Coast Company, LLC USA, CCOGS151 <br />1 <br />I <br />LOCATION WITHIN SITE (Optional) 431 <br />I. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local <br />agency.) <br />TANK ID #432 <br />TANK MANUFACTURER 433 <br />COMPARTMENTALIZED TANK Yes No 434 <br />71 <br />TRUSCO <br />N "Yes', complete one page for each compartment. <br />DATE INSTALLED (YEAR/MO) 435 <br />TANK CAPACITY IN GALLONS 436 <br />NUMBER OF COMPARTMENTS 437 <br />1995 <br />12,000 <br />ADDITIONAL DESCRIPTION (For local use only) 438 <br />II. TANK CONTENTS <br />TANK USE 439 <br />PETROLEUM TYPE 440 <br />® 1. MOTOR VEHICLE FUEL <br />® 1a. REGULAR UNLEADED O 2. LEADED O 5. JET FUEL <br />(H marked complete Petroleum Type) <br />❑ 1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL <br />❑ 2. NON -FUEL PETROLEUM <br />❑ 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER <br />❑ 3. CHEMICAL PRODUCT <br />COMMON NAME (iron Hazardous Materials Inventory page) 441 <br />CAS# (from Hazardous Materials Inventory page) 442 <br />❑ 4. HAZARDOUS WASTE <br />UNLEADED FUEL <br />800-61-9 <br />(Includes Used Oil) <br />O 95. UNKNOWN <br />111. TANK CONSTRUCTION <br />TYPE OF TANK 0 1. SINGLE WALL 3. SINGLE WALL WITH 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br />(Check one item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN <br />® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT O 99. OTHER <br />TANK MATERIAL - primary tank 0 1. BARE STEEL 3. FIBERGLASS / PLASTIC 5. CONCRETE 95. UNKNOWN 444 <br />(Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/ ❑ 99. OTHER <br />REINFORCED PLASTIC (FRP) 1000/6 METHANOL <br />TANK MATERIAL -secondary tank 1. BARE STEEL 3. FIBERGLASS / PLASTIC 0 5. CONCRETE 0 95. UNKNOWN 445 <br />(Check one item only) ❑ 2. STAINLESS STEEL ® 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE ❑ 99. OTHER <br />REINFORCED PLASTIC (FRP) W/100% METHANOL <br />❑ 5. CONCRETE ❑ 10. COATED STEEL <br />TANK INTERIOR LINING O 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 447 <br />OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99 OTHER <br />(Check one item only) (For local use only) <br />OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 <br />PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER <br />(Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) <br />SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 <br />OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br />(Check all ® 1 SPILL CONTAINMENT <br />that apply) �tqq& 2 0-1 <br />❑ 1 ALARM ® 3 FILL TUBE SHUT OFF VALVE LINK <br />® 2 DROP TUBE 1995 Z b Uvl <br />O 2 BALL FLOAT O 4 EXEMPT <br />® 3 STRIKER PLATE 1995 <br />IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) <br />IF SINGLE WALL TANK (Check all that apply) 453 <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br />(Check one item only) <br />❑ 1 VISUAL (EXPOSED PORTION ONLY) O 5 MANUAL TANK GAUGING (MTG) <br />❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) <br />❑ 2 AUTOMATIC TANK GAUGING (ATG) ❑ 6 VADOSE ZONE <br />® 2 CONTINUOUS INTERSTITIAL MONITORING <br />❑ 3 CONTINUOUS ATG [:17 GROUNDWATER <br />❑ 3 MANUAL MONITORING <br />❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING <br />+ (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER <br />IV. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (YR/MO/DAY) 455 <br />ESTIMATED QUANTITY OF SUBSTANCE <br />REMAINING <br />TANK FILLED WITH INERT MATERIAL? 457 <br />gallons <br />❑ Yes ❑ No <br />UPCF (12/99 revised) Formerly SWRCB Form B <br />