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UNIFIED PROGRAM CONSOLIDATED FORM UNDER OUND STORAGE TANKS -*K PAGE 1 TANKS (two pages per tank) Page_of TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Cheek one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ® 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: t Beacon Station#3698 3 LOCATION WITHIN SITE(Optional) 431 I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK C1 Ye-s® No 434 3698-2 Modern It'Yes-,complete one page for each compartment. DATE INSTALLED(YEAR/M0) 435 TANK CAPACITY IN GALLONS -436 NUMBER OF COMPARTMENTS 437 1/87 10152 1 ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE - 440 ®1. MOTOR VEHICLE FUEL []1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked complete Petroleum Type) 01b. PREMIUM UNLEADED 03. DIESEL (2 6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ®ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Haaerdam Materials Inventory page) 441 CAS#(Ram Hasardaus Materials Inventory page) 442 - ❑4. HAZARDOUS WASTE 8006-61-9 (Includes Used Oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH [IS. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN M2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank ®1. BARE STEEL ❑3. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPATIBLE W/ [199.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secondarytank [11. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 (Check we item only) ❑2. STAINLESS STEEL 0 4.STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE [199.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑3.EPDXY LINING ❑S.GLASS LINING ❑95.UNKNOWN 1 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑i MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Cheek one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENMYEAR INSTALLED 452 (Chock all ®i SPILL CONTAINMENT Net apply) 1/87 ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 1/87 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 1/87 IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the lad agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check ane INm only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING INTO) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑8 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/Mo/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B