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IED PROGRAM CONSOLIDATED FORM TANK: T"n tt% PRN: PRO518293 UNDERGROUND STORAGE TANKS -TANK PAGE I 8(j�a� FAC N: FAMIn4sa. (two pages per tank) TYPE OF ACTIONEl 1 Page 4 of 5 NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANGE OF INFORMATION bTEMPORARY SITE CLOSURE (Check mh�item only) ❑ .. ❑ ]PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT (Spcc4 rmson.fm local ueconN) (Spa Finaaon-1'w loasluu onh9 ❑ ❑ 8 TANK REMOVED 430 BUSINESS NAME IS.a FACILITY NAME m DBA-Dan.Bmim ca As) 3 F Clop '3(r ok- S� 1 RAPID SERVICE CENTER LOCATION WI'T'HIN SITE(opuona) 3550 S HWY 99,S IMIK I ON 431 PHONE L TANK DESCRIPTION(A scaled plat plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# Tank#: 2a TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ®yes ❑No 434 .Zen� ,�{,�6 rj<0S Y I MODERN WELDING CO INC If-Ya",canpletc me page fm m6c mpunnca DATE INSTALLED(YEAR/MO) 5nr/o �r p.��y TANK CAPACITY M GALLONS 436 NUMBER OF COMPARTMENTS 431 ` 3,000 ADDITIONAL DESCRIPTION Ire,(w meaaK) 438 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® 1.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑2.LEADED El 5.JET FUEL "o (lfmad Plme Petroleum T)w) .PREMIUM UNLEADED 3.DIESEL ElI bPRE ® ❑ b.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL F13.CHEMICAL PRODUCT El 99.OTHER COMMON NAME(rmm xa>ardom Mmenels Immtmpage) 441 CAS#(fmm Hmarbous Metedela mvemmv page) 442 ❑4.HAZARDOUS WASTE (1.1W Uw ap ❑ 95.UNKNOWN TIL TANK CONSTRUCTION TYPEOFTANK El 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Cleek one item only) EXTERIOR MEMBRANE LINER El 95 UNKNOWN 912.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑99.OTHER TANKMATERIAL-primary tank ® LBARE STEEL ❑FIBERGLASS/PLASTIC El.CONCRETE E] 95 UNKNOWN 444 (Chink um item oah) ❑ 2.STAINLESS STEEL ❑STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ W9 OTHER TANK MATERIAL-secondary tanic ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check ane one mh) ❑2.STAINLESS STEEL ®4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE WOW%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑3.EPDXY LINING 5.GLASS LINING 442 OR COATING ❑ ❑95.UNKNOWN 446 DATE INSTALLED (Okeck om item ouh) ❑ 2ALKYD LMING ❑ 4PHENOLIC LINING ®6UNLINED ❑ 99 OTHER (Far oral memh) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTICUs PROTECTION IF APPLICABLE PROTECTION ❑9 SUNKNOWN 49B DATEINSTALLED (Dh krine item onh) ❑ 4 IMPRESSED CURRENT ❑"OTHER ❑ 2SACRIFICIAL ANODE (Far law uxaJl) SPILL AND OVERFILL YEAR MSTALLE450 TYPE(lowuaeonly) 451 OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED 453 (L dlWtapph) ® I SPILL CONTAINMENT 1,995.00 A1004-010 ❑ IALARM FYI 2DROP TUBE 1,995.00 A20-10/A1100-1 ®4EXEFILMPT SHUT OFF VAL` 1,995.00 XJ 3 STRIKER PLATE 1,995.00 STEEL PLATE ❑ FLOAT ❑ PT IV.TANK LEAK DETECTION(A 4sripum Drina mnnia�ne vra�am eh.n x mEmitmd m uK bml.gcm>:) IF SINGLE WALL TANK(Ouska111hu apph) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 i EXPOSED PORTION ONLY) (Chw:mini.aJy) ❑ 1 VISUAL( Y) ❑ 5 MANUAL TANK GAUGING(MTG) 2 AUTOMATIC TANK GAUGING ATG ❑ I VISUAL(SINGLE WALL M VAULT ONLY) ❑ (ATG) ❑ 6VADOSE ZONE ❑ 3 CONTINUOUS ATG ❑ l GROUNDWATER 912 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑ 99 OTHER 3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAMNG 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑No UPCF(12/99 revised)