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Nf 75 <br /> IFIED PROGRAM CONSOLIDATED FORD - <br /> \/ ANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> sees (two them tank) <br /> TYPE OF OF ACTLON SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (C6ert mefo®oab') ❑ 7 PERMANENTLY CLO SED <br /> ❑ 3 RENEWAL PERMIT (sped(y. =-F.I. awy) (Speciym -T.Iow.4oaly) S TANKREMOVED 430 O� <br /> BUSINESS NAME F m3TY .DBA-Deity9umwalM) 3 FACILITY ID: ,7 t <br /> Lir ©lf' > .✓ .� :. 16 , 7 <br /> LOCATION WITHIN SITE( ) <br /> /DDD N. �Gr 5T • 9VD n 00 o-394) <br /> L TANK DESCRIPTION (A scaled plot plan with the location of the UST system mchichng bW]dhw and landmed®shell be submitted to the 1oca1 agewy.) <br /> TANK IDk 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK U Ye 0 4x <br /> ll"Y.^.>imPle¢mePKRae.h unPenmm� <br /> DATE INSTALLED(YE AVMO) 4V TANK CAPACITY IN GALLONS 430 NUMBER OF N 437 <br /> ADDITION DISCRETION(F.ton Cr!/ <br /> 439 <br /> IL TANK CONTENTS <br /> TANKUSE 4H PETROLEUM TYPE 4p <br /> ❑1. MOTOR VEHICLE FIEF. ❑1i RBOULAR UNLEADED ❑2. LEADED ❑S. TET FUEL <br /> (Imehe4r®plae Peo-olwoo Type) ❑lb. PREMIUM UNLEADED 03. DIESEL p6. AVIATION FUEL �/ <br /> ❑2.NON-FUEL PETROLEUM ❑It. MIDGRADE UNLEADED _ ❑4.GASOHOL .OTHERZt-e 'C('f' <br /> ❑3.CHEMICAL PRODUCT COMMON NAME(wmLleallo.Mn.iW lvwu.ymp) MD CASk(a.o ReallowM..iNelurmaaypege) uD <br /> ❑4. HAZARDOUS WASTE.� <br /> (Led 1. 1 Ou) <br /> 095.UNKNOWN O/L <br /> M. TANK CONSTRUCTION <br /> TYPE OF TANK -SINGLE WALL U 3.SINGLE WALL WITH LI S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Ch.to Onb) EXTERIOR MEMBRANE LINER 095.UNKNOWN <br /> ❑2. DOUBLE WALL ❑4.SIGNLE WALL IN VAULT ❑99. OTHER <br /> TANKMAT'ERIAL-m .BARE STEEL 3.FIBERGLASS/PLASTIC 135.CONCRETE 95.UNKNOWN 414 <br /> (Ca:ao.i..iy) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FBEROIARS ❑S.FRP COMPTLELE W/100%MEFHANOL [199.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-.cmmy e.a Ll 1. BARE STEEL 3. FIBERGLASS/PLASTIC U S. CONCRETE 13 95.UNKNOWN 145 <br /> (Ctert ma iimmb) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS (38. FRP COMPTIBLE Wn00%METHANOL ❑99.OMM <br /> REINFORCED PLASTIC(FRP) ❑10.COATED STEEL <br /> 0 S. CONCRETE <br /> TANK INTERIOR LB41NO ULRURBEERLINED U 3.EPDXY LINING 13 S.GLASS LINING 13 95.UNKNOWN 416 DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LIININGE399 OTHER <br /> (ca.t itanaatr) 6NINLWP.D (F.loale.®b) <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC,- 3LUNKNOWN 448 DATE INSTALLED 449 <br /> PROTECUON IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER <br /> (ch.a me0mwlY) ❑2 SACRIFICIAL ANODE (F.Imtu.avb) <br /> SPIT AND OVERFILL YEAR INSTALLED 450 TYPE e.4Ny) 4n OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 4n <br /> (C6 .Hd.epply) ❑I SPILL CONTAINMENT ❑1ALARM ❑3 FILL TUBE SHUT OFF VALVE <br /> ❑2 DROP TUBE [32 BALLFIAAT J [34 EXEMPT <br /> ❑3 STRIKER PLATE f Oen <br /> IV.TANK LEAK DETECTION(A du.imimulme.eoke mop®eheuxwlwoiee4mme1.d eameyd <br /> IF SINGLE WALL TANK(C6.a w oet with 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> (CC6.k ooe i (SI <br /> AL(EXPOSED PORTION ONLY) 13S MANUAL TAMC GAUGING(MIO) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATO) ❑6 VADOSE ZONE ❑2 CONTINUOUS INT'ERsTMAL MONITORING <br /> ❑3 CONTINUOUS ATO ❑7 GROUNDWATER 0 3 MANUAL MONITORING <br /> 04 STATISTICAL INVENTORY RECONCILIATION ❑STANK.TESTING <br /> (SIR) BIENNIAL.TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> (YR/MO/DAY) 453 ESTIMATEDQUANTITYOFSUBSTANCEREMAWINO 456 TANKFIILEDWITHINERTMATeRIAL? 43D <br /> /t/J gallons ❑Yee o <br /> E31'AIA7ED7E LAS U <br /> UPCF(12/99 revised) t0 Formerly SWRCB Form B <br />