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U NIFIED PROGRAM CONSOLIDATED FORM TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Mn pages per tank) <br /> Page _ al <br /> [3 5. TEMPORARY SITE CLOSURE 00 <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT El 4. AMENDED PERMIT 5. CHANGE Of INFORMATION) ❑ T PERMANENTLY CLOSED ON SITE <br /> (Check one dem only) f`II� <br /> ❑].RENEWAL PERMIT (5perly nasan-rorlocel ma omyJ (Spzdy charge-rorlac4l use any) ❑ 8. TANK REMOVED 00 1 (� <br /> B SINESS NAME(Same as FACILITY NAME or DBA-ODing Bu eas As) FACILITY ID/ 1 "a <br /> a ��� FC <br /> LOCATION WITHIN SITE(OpConeO 431 <br /> I.TANK DESCRIP71ON Ac-I <br /> TANK IDa TANK MANUFACTURER COMPARTMENTALIZED Ha.iV'EDTANK A ❑ Yes <br /> /A{� II ,mmplela one Dage to'..,h camparnenl. <br /> © TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> DATE INSTALLED(YEARMIO) s, <br /> AODITIO LD RIPTION(ForbcL me ony) 1 <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> . REGULAR UNLEADED 132.LEADED ❑ 5. JET FUEL <br /> I. MOTOR VEHICLE FUEL ❑ S. AVIATION FUEL <br /> lI aAad,complero Pafra.Mum Type) ❑15 PREMIUM VNLEAOED ❑ ]. DIESEL <br /> ❑ 2. NON FUEL PETROLEUM ❑tc MIDGRADEUNLEADED ❑ 4 GASOHOL 099. OTHER <br /> ❑ 3. CHEMICALPRODUCT COMMON NAME(hem HazaNOus Mafenals hhhmhWP'2k) CASM(ham Hazardous MeleddlcfinentorypageJ <br /> ❑ 4, HAZk RDDUS WASTE(Includes <br /> Used 010 <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BIAGOER SYSTEM <br /> EXTERIOR MEMBRANE LINER 0 9 UNKNOWN <br /> (Check one Item only) . DOUBLE WALL '❑ 4 SINGLE WALL IN A VAULT <br /> ❑99 OTHER <br /> TANKMATERIAL-pnma,tank1BARE ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN <br /> . <br /> (Coach we item ony) ❑ 2. STAINLESS STEEL ❑ 4 RSTEEL CLAD E NFORCED PLASTIC(FRP) ❑ 8. FRP COMPATIBLE W/100!5 METHANOL ❑99, OTHER <br /> TANK MATERIAL-secondary tank 1 BARE STEEL ❑ 3. FISERGIASS/PLASTIC ❑ 8. FRP COMPATIBLE W/1g0%METHANOL ❑95. UNKNOWN <br /> (Chackdne3emoNy) 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGUSS [19. FRP NON-CORRODIBLE JACKET El sq.OTHER <br /> REINFORCED PLASTIC(FRP) ❑10 COATED STEEL <br /> TANK INTERIOR LINING <br /> ❑ 5. CONCRETE <br /> ❑ 1. RUBBER LINED ❑ EPDXY LINING <br /> ❑ 5. GLASS LINING ❑95. UNMOM433 DATE INSTALLED <br /> ORCOATING ❑ Z. ALKYD LINING PHENOLIC LINING ❑ B. UNLINED C1 99, OTHER (Fcrlocal use onl) <br /> (Check oro item doll DATE INSTALLED <br /> [0195 UNKNOWN <br /> OTHER CORROSION MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC 434 <br /> PROTECTION IF APPUCABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99.OTHER <br /> (Forbcal me any) <br /> (CheckaneitemdMy) ❑ 2. SACRIFICIALANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Far tical use an) <br /> (Check all that app) 1. SPILL CONTAINMENT 1.ALARM _ ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROPTUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> N.TANK LEAK DETECTION <br /> IF DOUBLE WALL TANK OR TANK WITH BLADDER Check dneifaman ): <br /> IF SINGLE WALL TANK Check all Mata 1: <br /> ❑ 1, VISUALAUTOMATIC <br /> TICTA K PORTION ONLY) <br /> ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> ❑ Z. AUTOMATIC TANK GAUGING(ATG) ❑ 5. VADOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECON CILIATION(SIR) ❑ S. TANKTESTING <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE UST USED(YRlM01DAY) <br /> ESTIMATED OUANTITY Of SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> paeans ❑Vas ❑No <br /> CUPAFORM(4199) • • Formerly SWRCB Form 6 <br />