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UI FIE D PROGRAM C QNSOLI DATED F OR4' <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Mv Pages Per lank) <br /> Papa _ of _ <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT 0 4.AMENDED PERMIT 0 5. CHANGE OF INFORMATION) ❑ 0. TEMPORARY SITE CLOSURE <br /> (C)aok onto item onty) 0 ]. PERMANENTLYCLOSED ON SITE <br /> 03.RENEWAL PERMIT (Spodfy mown-Iwloulvu oMy) (Specify charps-IorlocN Va onM 0 8. TANK REMOVED 430 l�J/ <br /> BUSINESS NAME(Sem.as FACILITY NAME of DBA-Doing Bwkrea Aa) p FACILITY ID Y <br /> c ,AISi WJ MARL Kc F161010[1]3W 1 <br /> LOCATION WITHIN SITE(Opltontio Al <br /> yg5o vov 1 cow Swvcxziu•� ,cr.1.TANK DESCRIPION 1�\a <br /> T 1 <br /> TANKIDY /�/� TANK MANUFACTURER COMPARTMENTAUZEOTANK ❑ Yes O No <br /> 39 cxoa 31 oa8010 a-8 0(o If•Yea',complete one papa M eaU campaAmanl. <br /> DATE INSTALLED(YEARIMO) TANK P...TYI LLONS NUMBER OF COMPARTMENTS <br /> 3-1 - (p S o00 ( ��y <br /> ADDITIONAL DESCRIPTION(Forbcal o»omy) 1II� <br /> It.TANK CONTENTS <br /> TANK USE 433 PETROLEUM TYPE <br /> 0 1. MOTOR VEHICLE FUEL D Is. REGULAR UNLEADED ❑ 3. LEADED S. JET FUEL \\ <br /> IN manke <br /> e,compete Pefmleum Type) 015. PREMIUM UNLEADED Z3. DIESEL 0 8.AVIATION FUEL 1 <br /> ❑ 2. NON-FUEL PETROLEUM 1c:. MIDGRADEUNLEADED ❑ A. GASOHOL 0W. OTHER <br /> ❑ 3.CHEMIW CT CAB 0(hunt Hazallow Mateeala lneentprypa9a) <br /> ❑ 4. HAZARDOUS <br /> WASWASTE(Iriduesa COMMON NAME(Isom Heanus loMafadaM Inkanforype9)e <br /> wee ol9 <br /> n 25 um <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK .� 1, SINGLE WALL ❑ 3. SINGLE WALL VATH 11S. SINGLE WALL VATH INTERNAL BLADDER SYSTEM <br /> W2.(Dheck one dem only) Yp 2. DOUBLEWALL EXTERIOR MEMBRANE LINER 095. UNKNOVM <br /> D 4, SINGLE WALL IN A VAULT [IN. OTHER <br /> TANK MATERIAL-prvnary tank 'Ur,. SARE STEEL 0 3. FIBERGLASS/PLASTIC 0 S. CONCRETE 095. UNKNOWN <br /> (CMCkOM item oMy) 02. STAINLESS STEEL L7l STEEL CUD W/FIBERGLASS 08. FRP COMPATIBLE W lW%METHANOL 098. OTHER <br /> REINFORCED PLASTIC FRP) <br /> TANK MATERIAL-feconeary lent, 0 1 BARE STEEL ,0 33. FISERGLASSIPLISTIC 0 8, FRP COMPATIBLE W11W%METHANOL 95. UNKNOWN <br /> (Cock one Nem a*) 02 STAINLESS STEEL IG 4. STEEL CLAD WIFIBERGLASS 0 B. FRP NON-CORRODIBLE JACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) 010. COATED STEEL <br /> 0 5. CONCRETE ,��/ <br /> TANK INTERIOR LINING 0 1. RUBBER LINED D 3. EPDXY LINING 0 5,GLASS LINING /GIBS. UNKNOVJN433 DATEINSTALLED <br /> OR CWTING <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 8. UNLINED W. OTHER (lootical use <br /> (CMck nM dem en <br /> OTHER CORROSION U1 WNUFACTUREDCATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 434 DATEINSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 1. IMPRESSED CURRENT ❑Be. OTHER <br /> (CheckaM item aldY) ❑ 2. SACRIFlCIAL ANOO I I (For locelua oMw <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forbcalowordy) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check athat appM 1. SPILLCONTAINMENTftp_ 5JA( D1.ALARM �_ 3. FILL TUBE SHUT OFF VALVE_ <br /> 9'2. DROP TUBE -� 4' IZ 1A 2, BAI <br /> �t <br /> LL FLOAT I 0 4. EXEMPT <br /> 0 3, STRIKER PLATE <br /> " `-N. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK CWk all thaf apply): IF DOUBLE WALL TANK OR TANK VATH BLADDER Check oM item oM)' <br /> 01, VISUAL(EXPOSED PORTION ONLY) 0 5. MANUAL TANK GAUGING(MTG) c�❑y11. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> D 2. AUTOMATIC TANK GAUGING(ATG) D B. VADOSEZONE W9 2. CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3. CONTINUOUSATG 0 Z. GROUNDWATER 0 3. MANUALMONITORING <br /> 0 4. STATISTICAL INVENTORY RECONCILIATION(SIR) D B. TANK TESTING <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED GATE UST USED(YRMO/DAY) ESTIIMTEDOWNTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> gallons ❑Yes D No <br /> CUPAFORM(4199) 111 Formerly SWRCB Form B <br />