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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS- TANK PAGE I WANKS 0-pages per lank) TYPE OF ACTION ❑1 NEW SITE PERMYI' ❑ 4 AMENDED PERMITPage 1_of'` 5 CHANGE OF INIORMA'I'IUN ❑ 6 TEMPORARY SITE CLOSURE (Ched;one item only) - - - ----T-_ ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENL WAL PERMIT' (Spasify reuon-1'or local u on] y) (Specify reasntt-for]nca3 use onlly)y) ❑ $ TANK REMOVED BUSINESS NAME(Sam,.FACILrTYNAME,or DSA-WmgBLIsmcss&-) FACILTTYID: F A 43U E.F. KLUDT&SONS INC. 3 0 0 0 3 7 7 1 ' LOCATION WITHIN SIZE(optional) al corner 431 L TANK DESCRIPTION (A scaled plot plan with the It it of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 432 TANK MANUFACI[JRI R 433 6-UG COMPAR TIUENTALIZED TANK ❑Yes No 434 TRUS CO 47-yes".complm one page far each compartment DATE INSTALLED(YFAPJMO) 435 TANK CAP Crry IN GALLONS 436 1989/Dec. I0NUMBER OF COMPAR'1'MLNdS 437 ,000 ADDITIONAL DESCRIPTION nor Ioeel use only) one 438 H.TANK CONTENTS TANK USE 434 PETROLEUM TYPE I. MOTOR VEHICLE FUEL 440 ❑1a. REGULAR t1NI,EADF,B ❑2. LEADED ❑S. 7ETFUEL (lfmarked complete Petroleum Type) El 1b, PREMIUM UNLEADED ❑2. NON-FUEL PETROLEUM 3. DIESEL 1:16,AVIATION FUEL ®Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER 3. CHEMICAL PRODUCT COMMON NAME 441 (rm.Hazardous MaicriaL Inventory page) CASA(Gom Harardoua A4atenals inventory page; 442 ❑4. HAZARDOUS WASTE Gasoline nnducies l.lsed oil) 1195.UNKNOWN ITL PE FTANK TANK CONSTRUCTION TYOQ 1. SINGLE WALL 3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item ar ly) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN®2. DOUBLE WALL ❑4. SIONLE WALL IN VAULT ❑99. OTHER TANK MATEl2[AL-primary tank I- BARE STEEL 3.FlAERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN (Check om item only) ❑2. STAINLESS STEEL El 4. STEEL CLAD WTMERGLASS a ❑8. FRP COMPTIBLE wll@0%METHANOL ❑99.OTHER 444 REINFORCED PLASTIC(FRP) TANK MATERIAL-scmndary tank ❑1. BARE Sl-EEL 3. FIBERGLASS/PLASTIC 5, CONCRETE UNKNOWN 445 ❑95. (Check om item only) El 2. STAINLESS STEEL F-14, STEEL CLAD WlFIBERGLASS 08. FRP COMPTIBLIE W/]o0%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) Q 10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING I.RUBBER LINED 1 EPDXY LINING 5.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING EJ2 ALKYD LINING ❑4 PHENOLIC LINING 0 6 UNLINED (Chcak one item only) ❑99 OTHER (For IMw use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT (Check one ilem only) El SACRIFICIAL ANODE ❑99 OTHER SPILL AND OVERFILL YEAR INSTALLED 450 (For lethal use only) T YPE point use only) 45l OVERFILL PROTECTION EQUIFMENT:YEAR RSTALLED 433 fCheck all that apply) �]SPILL CONTAINMENT 2�()3 ®2 DROP TUBE ®I ALARM 2003 N 3 FILL TUBE SHUT OFF VALVE 2003 2003 ❑2 BALL FLOAT ❑4 EXEMPT 0 3 STRIKER PLATE 1989 IV,TANK LEAK DETECTION(A deaerepfinn of the ma utn ng program shell 6e suhmitlod to the local agency.) IF SINCrLE WALL TANK(Check all drat appl y} 45��p WALL TANK OR TANK WITH BLADDER 454 ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MSINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE UOUS INTERSTITIAL MONITORING 3 CONTINUOUS ATG ❑7 GROUNDWATERL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑S TANK TESTING (SIR) BIENNIAL TANK TESTING El 99 OTHER IV.TANK CLOSURE INFORMATION!PERI4IANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY`) 455 ESTIMATED gUANTI rl'Y OF SUBSTANCE REMAINING 454 TANK FILLED WITH INERT MATERIAL?. II/a n/a 457 gallons 0 Yes ® No UPCF(I2/99 revised) 10 Formerly SWRCB Form B