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UNIDD PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANKS - TANK PAGE 1 TANKS a� N (two pages per tank) TYPE OF ACTION ``11 r Paye80[Io ❑ 1 NEW SITE PERMIT ❑4 AMENDED PERMIT `�SCHA GE OF-INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) - .., _,. .. ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT ..(Speedy reason-for loaluse only) (Spcmfy reason for local use only) ❑STANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAMB m DBA-Doing Business M) FACILITY ID: 1 ARCO FACILITY#6335' 3 FA0007571 LOCATION WITHIN SITE(Optional) (� q SY s. a PHONE 431 I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to- local agency.) TANK ID# 432 TANK MANUFACTURER q33 COMPARTMENTALIZED TANK ❑Yes ❑No 434 XERXES If"Yes".co fete one Page for each w trent. DATE INSTALLED(YE 0) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3/16/1998 20,000 ADDITIONAL DESCRIPTION(For kcal use only) 438 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ® Ia.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL BfmarkedconWlete Pmmleum Type) El lb. 6.AVIATION FUEL 16.PREMIUM UNLEADED ❑ 3.DIESEL ❑2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑4.GASOHOL El 3.CHEMICAL PRODUCT ❑ 99.OTHER COMMON NAME(6om Hazardous Materiels lnvrntory page) 441 CAS#(from Hazardous Matcriala Iamwry page) El 4.HAZARDOUS WASTE 492 (Includes Used Oil) ❑95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Checkoneitemordy) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-prinmry tank El 1.BARE STEEL ®FIBERGLASS/PLASTIC El 5.CONCRETE El 9s.UNKNOWN 444 (Check one it=only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FBERGLASS ❑ 8.FRP COMPTBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEELFIBERGLASS/PLASTIC it item only) El S.CONCRETE El 95.UNKNOWN 445 (Cheek m ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS [:18.FRP COMPTBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑ 95.UNKNOWN 446 DATE INSTALLED aa7 OR COATING (Check one item only) ❑2 ALKYD LINING ❑4 PHENOLIC LININGED99.OTHER ® 6 UNLINED (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 9511NKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check one dem only) [:12 SACRIFICIAL ANODE ❑ 4 IMPRESSED CURRENT ❑99 OTHER (For kxel use only) SPILL AND OVERFILL / YEAR INSTALLED 450 TYPE(Wol use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ❑II PILL CONTAINMENT 1998 Z : Pt L L-au L{C ❑ 1 ALARM (],d'kD.I,TUBE SHUT OFF VALVE LXK DROPTUBE PL ❑ 2BALL FLOAT ❑4EXEMPT OPV,/ (p1 50 it ❑ 3STRIXER PLATE L 1V.TANK LEAK DETECTION(A description neve rrenhnriny prnyram anan x anbmincd to me low ayerey.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER 912 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING (SIR)BIENNIAL TANK TESTINGEl 99 OTHER ❑3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 allons ❑Yes ❑ No UPCF(12/99 revised)