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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 ' (Mo pages per ta,k) . / Page 5 TYPE OF ACTION U 1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5, CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Chec),PM dam 0nty) ❑ 7 PERMANENTLY CLOSED ON SITE ❑].RENEWAL PERMIT (SQA,Mason•for)Ocal uae ayy) (SpecAy-.No-for 10,41 use only) ❑ 6. TANK REMOVED Oso BUSINESS NAME(Same as FACILITY NAME of DBA•Dong Buaeleaa Aa) FACILITY IO a 1 � [ I= S6Y-p- ZZ3 �S�7 LOCATION WITHIN SITE(Opow++9 43I /� 1� {. � (- V tel✓�..C�.. r, L TANK DESCRIPTION TANK i0 a TANK MANUFACTURER II lD IA" T' T COMPARTMENTALIZED TANK Yea ❑ No •,P' yV-Q./�.h \� f• 1� +fit C It'Yes.mmpiota one Pago for aach eomPanmanl. 1 V ~ NUMBER OF COMPARTMENTS DAT INSTALLED(YEARMO) TANK UPACiTY IN GALLONS u3�-Q 000 - 8K KK AOOITICNALDESCRIPTION(FwlocaJu only) 11.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 2. LEADED ❑ 5 JET FUEL MOTOR VEHICLE FUEL ❑to EGULAR UNLEADED ❑ 6 AVIATION FUEL (it marked.cornprete Petrdeurn Type) 10 PREMIUM UNLEADED I C K ❑ ]. DIESEL ❑ 2. NON•FUEL PETROLEUM ❑ 4. GASOHOL ❑99 OTHER C] tc MIDGRADE UNLEADED ❑ ] CHEMICAL PRODUCTCAS a(from Hazarcous Matenals InHntory page) CO ON NAME(hom Hazanlaua Manuals Imren/ary page) O I, I - ❑ 4 HAZARDOUS WASTE(tndudes V (Jaed Od) �� j e AG S o III.TANK CONSTRUCTION TYPE OP TAN=KO NGLE WALL ❑ ]. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM EXTERIOR MEA48RANE LINER ❑95 UNKNOWN CneCk OM deOUB'EWAII ❑ 4 SINLE WALL IN A VAULT ❑99. OTHER 1 PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN TANK MATERARE STEEL ❑ ]. FIBERGLASS (Check oM dem ony) ❑ 2. STAINLESS STEEL C14. STEEL CLAD WJFIBERGLASS ❑ 6. FRP COMPATIBLE WJ100%METHANOL C199. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL•aecandary tank ❑ i BARE STEEL ❑ ]. FIBERGLASS 1 PLASTIC ❑ S. FRP COMPATIBLE WJ 100%METHANOL ❑95. UNKNOWN ,.., ❑99. OTHER (Check one rtem orMy) ❑ Z STAINLESS STEEL L!'4. STEEL CLAD NNFIBERGlA55 ❑ 9. FRP NON•CORROOIBLE JACKET _ REINFORCED PLASTIC(FRP) ❑10 COATED STEEL - ❑ S. CONCRETE pATEINSTALLEO TANK INTERIOR LINING ❑ 1. RU08ER LINED ❑ ]. EPDXY LINING ❑ 5 GLASS LINING ❑95. UNKNOWN4]] OR COATING PHENOLIC LINING 6 UNLINED ❑99. OTHER ❑ 2. ALKYD LINING C3 4, (For local ute 1 (ChKa one tem ) DATE INSTALLED OTHER CORRO51UN ❑ 1. MANUFACTURED CATHODIC ❑ ]. FIBERGLASS.REINFORCED PLASTIC ❑95 UNKNOWN 4]4 PROTECTION IF APPLICABLE PROTECTION ❑99. OTHER (F., vae only) �,� ❑ 4. IMPRESSED Cl(RRENT (Check arse 4er11 0,00 [7 2- SACRIFICIAL ANODE- 4 v a' 0�"1 YEAR INSTALLED. TYPE(Fw we ony) SPILL AND OVERFILL OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check as that apply) 1. SPILL CONTAINMENT QD ,.,/. ALARM ❑ ] FILL TUBE SHUT OFF VALVE ,.•al 0�U L72. BALL FLOA� G� ❑ 4. EXEMPT _ I�yS2�. DROP TUBE C.- STRIKER PLATE IV.TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER Check w�d- IF SINGLE WALL TANK a as Hut a _ ❑ 6, MANUAL TANK GAUGING(MTG) ❑ 1•�rISUAL(SINGLE WALL IN VAULT ONLY) - ❑ 1, VISUAL(EXPOSED PORTON ONLY) L67/ f[03 2, AUTOMATIC TANK GAUGING(ATG) ❑ 6. VAOOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING ❑ ]. CONTINUOUS ATG - - ❑ 7. GROUNDWATER _ ❑ ]. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ S. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 4]S TANK FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YRMO/OAY) .-.. ESTIMATED QUANTITY OF SUBSTANCE REMAINING - -•.. -_.__ geliw+a ❑Yes ❑Ne / Forrner(y SWRCB Form B CUPAFORM(4199) D8/a/�U/