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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 ugil <br /> (Wo pages per tank) <br /> Page _ pl <br /> TYPE OF ACTION )11.NEW SITE PERMIT ❑ 1. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE <br /> (Check ane Mm oom ❑ T. PERMANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT (Syedfy Maon-Mbc•N psryMN (Seedy charps-krtocel vas onM ❑ S. TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Going Steven Aa) `b11S FACILTTYIDe 1 <br /> LOCATION WITHIN SITE(OYHOW 431 <br /> 1.TANK DESCRIPTION <br /> TANK IDR TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes <br /> LwV-Vlc)w v) II-Yea',mmplale one page for each compaamenl <br /> DATE INSTAL''LEED(YEARNO) TANKCAPACITYIN GALLONS NUMBER OF COMPARTMENTS <br /> Lul IC f l yl I nvvD I <br /> ADDITIONAL DESCRIPTION(Forb use ppW <br /> IL TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> ,lWa1. MOTOR VEHICLE FUEL ❑Is. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (BmehW'oompleta PNrok,e Tye) ❑lb. PREMIUM UNLEADED k3. DIESEL ❑ B.AVIATIONFUEL <br /> ❑ 2. NON-FUELPETROLEUM ❑1c, MIDGRADEUNLEADED ❑ 4. GASOHOL 1199. OTHER <br /> ❑ 3. CHEMICAE(Im'Wss COMMON NAME(9otn HezatWue Masashi ory papa) CAB#(hom Haaael o.MaheoW.lnwntorypags) <br /> 00) JS <br /> 95 UNKNOWN <br /> ❑ <br /> 1. HALIWASTE <br /> UaaO Dig <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 01, SINGLE WALL ❑ 3. SINGLE WALL VATH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Ceeck pm Ham only) ❑ 2, DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER <br /> TANK MATERIAL-pbmny Wnk 1. BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE 13 m, UNKNOWN <br /> (Ch on,tlem pew Cl 2. STAINLESS STEEL 04. STEEL CIAD WFIBERGLASS ❑ S. FRP COMPA7181-E W/100%METHANOL ❑N. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK WTERIAL-second"tank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ S. FRP COMPATIBLE WIWO%METHANOL ❑95. UNKNOWN <br /> (Check one"m only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ B. FRP NON-CORRODIBLE JACKET IM9. OTHER VICA^2 <br /> REINFORCED PLASTIC(FRP) 1310. COATED STEEL <br /> ❑ S. CONCRETE <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED 133. EPDXY LINING 115. GLASS LINING 110, UNKNOWN41M DATE INSTALLED <br /> OR COATING 11ChecNopaHNn 2. ALKYD LINING ❑ I. PHENOLIC LINING 11e. UNLINED tom .qAh. OTHER f.L4l�� (FprkcNusa <br /> opw <br /> OTHER CORROSION ❑ 1. MANUFACTUREDCATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 436 DATE INSTALLED <br /> P0.0TECDON IF APPLICABLE <br /> LICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT O099. OTHERYIDVLQ.. <br /> (Dhxk oru NmaMOi ❑ 2. SACRIFICIAL ANODE (Forkwl uae oMy) <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forc use poK OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Chackaa MatappW ❑ 1 SPILL CONTAINMENT An <br /> �- ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ✓I0 yL e� 112. &ILL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE M \k/L <br /> IV. TANKLEAKOETECTION <br /> IF SINGLE WALL TANK Chack aN that apply) IF DOUBLE WALL TANK OR TANK WITH BLADDER Chock one Item only) <br /> ❑ 1. VISUAL(EXPOSEDPORTION ONLY) ❑ S. MANUAL TANK GAUGING(MM) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(AM) ❑ 6. VADOSEZONE ❑2. CONTINUOUSINTERSTITIALMOATORING <br /> ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑4. STATISTICALINVENTORY RECONCILIATION(SIR) ,L1yng❑ 8. TANKTES1TI1NG �� /� <br /> BIENNIAL TANK TESTING . OTHER .TI`OF VC <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED1, [YRAAO1IDDAY) ESTIMATED QUAN//T]]ttV OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> AAjV,K0W Vt 2�1 (VIC_VI.P_S .- ❑Yea CLf p <br /> Ti45155�5 <br /> y �a R � <br /> CUPAFORM(4/99) Q,r. ,wL� •-M' 16 C(S�� Fo SWRCB Farn16 <br />