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1 <br /> UnIFIED PROGRAM CONSOLIDATED FOR ==TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 17 <br /> Page _ of <br /> ❑ 5. CHANGE OF INFORMATION) ❑ 8.TEMPORARY SITE CLOSURE <br /> 4.TYPE OF ACTION NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 7, PERMANENTLY CLOSED ON SITE <br /> (Check one item only) T <br /> ❑3.RENEWAL PERMIT (Specify reason-for at use only) (Specify change-for local use only) ❑ 8.TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Bu3iness As) <br /> FILLij <br /> ACILITY ID# 1 <br /> T T Y17�w. ,�stx✓� �_� �1 <br /> LOCATION WITHIN SITE(Opflonao 431 <br /> I.TANK DESCRIPTION <br /> TANK MANUFACTURER COMPARTMENTALIZED TANK C'es ❑ No <br /> TANK to# If-Yes',complete one page for each compartment. <br /> ,-F S 71f0-554,1/6 Moves <br /> DATE INSTALLED(YEARIMO) <br /> TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> Y�i3�oN S o d <br /> ADDITIONAL DESCRIPTION(Forlocal use only) <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE ❑ 5. JET FUEL <br /> ❑1e. REGULAR UNLEADED ❑ 2. LEADED <br /> MOTOR VEHICLE FUEL - ❑ 3. DIESEL ❑ 5.AVIATION FUEL <br /> ( marked,complete Petroleum Type) tb. PREMIUM UNLEADED <br /> ❑ 2. NON-FUEL PETROLEUM ❑ 4. GASOHOL ❑99. OTHER <br /> 1e. MIDGRADE UNLEADED <br /> ❑ 3.CHEMICAL PRODUCT CAS#(from Hazardous Materials inventory page) <br /> COMMON NAME(from <br /> He Materials Inventory page) <br /> ❑ 4. HAZARDOUS WASTE(Includes <br /> Used Oil) <br /> 95, UNKNQ <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL HATH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> r� EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> (Check one ifem only) 0 '. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT ❑99.OTHER <br /> TANK MATERIAL-primary tank 3.BARE STEEL <br /> ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> (Check one item only) ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ 8. FRP COMPATIBLE W1100%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> rTANK <br /> MATERIAL•secondary tank ❑ 1 BARE STEELS. FIBERGLASS!PLASTIC ❑ 8. FRP COMPATIBLE WI100%METHANOL ❑95. UNKNOWN <br /> ck one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET <br /> ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) ❑10.COATED STEEL <br /> ❑ 5. CONCRETE DATEINSTALLED <br /> INTERIOR LINING ❑ 1, RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 <br /> COATING El4. PHENOLIC LINING *5. UNLINED ❑99. OTHER or local use only) <br /> [1 2. ALKYD LINING - DATE INSTALLED <br /> (Check one item onl) <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC NY'-3. FIBERGLASS REINFORCED PLASTIC ❑99 OTHER 434 <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT (For local use only) <br /> (Check one item only) ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only) tti��� ��y,�7 <br /> (Check all that apply) ❑ 1. SPILL CONTAINMENT LWilt 1,ALARM G77c3rSl = ❑ 3. FILL TUBE SHUT OFF VALVE <br /> 7 vrwcL)+� 2. SALLFLOAT`4ZZ ❑ 4. EXEMPT <br /> ❑ 2. DROP TUBE <br /> 7�ryN <br /> ❑ 3. STRIKER PLATE AV&en2 _ <br /> IV,TANK LEAK DETECTION <br /> _ - IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item ON). <br /> IF SINGLE WALL TANK Check all that a ): <br /> ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) . <br /> ❑ 7, VISUAL(EXPOSED PORTION ONLY) ❑ 8. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING <br /> C32. AUTOMATIC TANK GAUGING(ATG) C1 7 GROUNDWATER ❑ 3. MANUAL MONITORING <br /> C13. CONTINUOUS ATG <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑ 8. TANK TESTING <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> 435 TANK FILLED WITH INERT MATERIAL? <br /> ESTIMATED DATE LAST USED(YRIMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING _ <br /> gallons ❑Yes ❑No <br /> Formerly SWRCB Form B <br /> CUPAFORM(4199) <br />