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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (Two pages per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430, (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Bnsmess As) 3. FACILITY ID: 1 United Parcel Service,Inc. LOCATION WITIIIN SITE(optio ) 431. L TANS DESCRIPTION (A scaled plot plan with tf)eL locatiQU of the UST systema inoludinig buildings.and 1atldmat s Aill be submitted to the 10"IL agency.) TANK ID# 432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK ❑Yes ® No 434. 1 Owens Comity If"Yes,^complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 (YEAR/MO) 1991 10,000 1 ADDITIONAL DESCRIPTION(For local use only) 438. II. TANK CONTENTS TANK USE 439, PETROLEUM TYPE 440. El 1, MOTOR VEHICLE FUEL 0 la. REGULAR UNLEADED ❑2. LEADED ❑5. 3ET FML (If checked,complete Petroleum Type) ❑I b. PREMIUM UNLEADED [13. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLELIIA ❑1 a MDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (fimn Haardous Materials Inventory page) 441. CAS#(from Hamdow Materials hrventory page) 442. ❑ 4. HAZARDOUS WASTE Gasoline 86290-81-5 (Includes Used Oil) ❑ 95.UNKNOWN III.T �CUNSTRi:TCTtON TYPE OF TANK ❑I. SINGLE WALI. [13, SINGLE WALL WITH EXTERIOR ❑S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN ®2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT [199. OTHER TANK MATERIAL-primary tank ❑1. BARE STEEL 03. FIBERGLASS/PLASTIC ❑S. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC(FRP) W/1001%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING [11.RUBBER LINED ❑3.EPDXY LINING ®5.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447, OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ❑6.UNLINED ❑99.OTHER 1991 (Check one item only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC ®3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER 1991 (If A licable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451, OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452, (Check all that apply) ®1.SPILL CONTAINMENT 1991 ®1.ALARM 1991 ®3.FILL TUBE SHUT OFF VALVE 1991 ®2.DROP TUBE 1991 ®2.BALL FLOAT 1991 ❑4.EXEMPT ❑3.STRIKER PLATE IV. TANK LEAK DETECTION (A description of the monitori.4 prmiramn shall be submitted to the 1-1 a cy.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑1.VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE E 2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑T GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99.OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/I,40/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457. gallons ❑Yes ❑ No UPCF hwfwre-b(1/99)-1/4 http://www.unidoc&org Rev.02/16/00