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UNIFIED PROGRAM(UP) FORM UNDERGROUND STORAGE TANKS-TANK PAGE 1 two pages per tank Page of TYPE OF ACTION 01.NEW SITE PERMIT ❑3.RENEWAL PERMIT ❑5.CHANGE OF INFORMATION ❑TPERMANENTLY CLOSED SITE (Check one item only) ❑2.INTERIM PERMIT (:14.AMENDED PERMIT ❑&TEMPORARY SITE CLOSURE ❑ B.TANK REMOVED 430 BUSINESS NAM E(San*ss FACILITY NOME or 08A) FACILITY tD: o Valle Pack Petroleum Services Inc. 3 F A LOCATION WITHIN SITE(optional} / /V43L'e- 431 1. TANK DESCRIPTION 1A scaled plot plan YAM locations of UST svVemWinoluding buildings and landmarks shall be submitted to the CUPAa PA. TANK ID# 4a2 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes 1531 No 434 1 TrusC0 If-Yes*.oemplete one page.for each woipartmert. DATE INSTALLED(YEARIMO) 435 TANK CAPACITY IN GALLONS 4M NUMBER OF COMPARTMENTS 437 1997 20,000 Gal 1 ADDITIONAL OESCRI PTION(Forsocal use ally) 438 11. TANK CONTENTS TANK USE 439 PETROLEUMTYPE 440 ®1. MOTOR VEHICLE FUEL ❑la- REGULAR UNLEADED ❑2. LEADED ❑5_ JET FUEL m 013 it narked complete PeType) ❑1b• PREMIUM UNLEADED ®3. DIESEL ❑6_ AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER: N p 3. CHEMICAL PRODUCT COMMON NAME 411 CAS# 442 cv (from Hazardous Metedals Invremwy page) 1from Haxardoue Materials Inremay pagey m ❑4. HAZARDOUS WASTE(Includes Chad okl GARB Diesel 08478-346 cn ❑95.UNKNOWN 0 Ill. TANK CONSTRUCTION r TYPE OF TANK 1. SINGLE WALL 0 3, SINGLE WALL WITH S. SINGLE WALL WITH INTERNAL BLADDER ;(Che,^.k one darn only} EXTERIOR MEMBRANE LINER 095. UNKNOWN 443 m 0312. DOUBLE WALL ❑4. SIGNLE WALLIN VAULT ❑99. OTHERC13 _ t- TANK MATERIAL-p ma y tank 1. BARE STEEL 3. FIBERGLASS!PLASTIC 0 5. CONCRETE ❑96. UNKNOWN J ;iCheck one darn only} ❑2. STAINLESS STEEL [14. STEEL CLAD WIFIBERGLASS [38. FRP COMPTIBLE W1100%METHANOL Q 99.OTHER 444 v REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank 0 1. BARE STEEL 3. FIBERGLASS/PLASTIC C1 5. CONCRETE 95. UNKNOWN N } <�D ;krhe.lk one dam only' D 2. STAINLESS STEEL 04. STEEL CLAD WfFIBERGLASS ❑8. FRP COMPTIBLE W1100%METHANOL❑99.OTIiER 445 �c REINFORCED PLASTIC(FRP) [110-COATED STEEL <I' TANK INTERIOR LINING ❑1.RUBBER LINED 0 3.EPDXY LINING ❑5.GLASS LINING 95.UNKNOWN DATE INSTALLED 447 00 N OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER 446 (For lora)use ary) z (Check one item iy) OTHER CORROSION 1 MANUFACTURED CATHODIC 0 3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN DATE INSTALLED 448 PROTECTION(IF APPLICABLE) PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER j 448 {For local use Orly} (Check one Item only) ❑2 SACRIFICIAL ANODE j SPILL AND OVERFILL ;Check ell that apply) YEAR INSTALLED 450 TYPE pOce0 use onM 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 J ®1 SPILL CONTAINMENT 2004 OPW-1C-21002 0 1 ALARM Gilbarco EMC 1997 0 2 DROPTUBE 2004 OPWBI 410 C ❑2 BALL FLOAT ® 3 STRIKER PLATE 1997 jMS00 Tanks 0 3 FILL TUBE SHUT OFF VALVE 97 ❑4 EXEMPT IV.TANK LEAK DETECTION(A desoiption dths monitomg proQnrn shall be sutmlded tothetocal agency l IF SINGLE WALL TANK tcheckall tkatsppryy 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 i (Caeck or*,WM orty) ! ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(64TG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADO.SE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING 0 4 STATISTICAL INVENTORY RECONCILIATION ❑B TANK TESTING (SIR) +BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRlll MAY) 456 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 TANK FILLED WITH INERT MATERIAL? 451 ❑Yes ❑ No OFFICIAL USE ONLY DATE RECEIVED TUPA PA DISTRICT4NSPECTOR UP FORM(112000 Version) 1 Formerly SWRCB Form B C> SBC UST-B.doC