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NTD <br /> t i'IED PROGRAM CONSOLIDATED FOR1_� IS o <br /> UERGROUND STORAGE TANKS -TANKPAGo ((�� i(two pages per tan <br /> TYPE OF ACTION W SITE PERMIT [34 AMENDED PERMIT 0 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (c�..uY) - 0 7 PERMANENTLY CLOSED ON SITE <br /> Cl 3 RENEWALPERMR 5psh ora-takNw a ) (Sperry suw-for rod ua ac Yl ❑ 8 TANKREMOVED 4l0 M <br /> $ N (Ymcu FACRITYNA oOBA-IbinpBu�/u) FACILITY ID: �� <br /> Jp .J Cer���N FA 5 � <br /> LOCATION WITHIN ITE(Ope ) 431 �O�l/d y <br /> SOd (ill£S / CDrt�✓p,C � P��r �l� OS0�3U� <br /> 1.TANK DESCR=ON (A scaled plot plan with the location of the UST syvm including bail -ngs and landmarks shall be submined to the 10 1 agency.) <br /> TANK U)# 4f 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes 0 No 431 <br /> vN/G <br /> DATE INSTALLED(YFAR/MO) 415 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> iL) G SO <br /> ADDITIONAL DESCRIPTION(Fa wol•--edy) <br /> IL TANK COPITENTS <br /> TANK USE 439 PETROLEUM TYPE aa: <br /> 0 1.MOTOR VEHICLE FUEL 0 la REGULAR UNLEADED C17- LEADED [15. =FUEL <br /> Nor' �TS ) O Ib. PREMIUM UNLEADED D3.DIESEL 06. AVIATION FUEL <br /> 02,NON-FUEL PETROLEUM ❑It. MIDGRADE UNLEADED 04. GASOHOL 099.OTHER <br /> 03. CHEMICAL PRODUCT COMMON NAME(6omt®ms M®W v m rpsA 401 CAS#(mm t�Jo-s M.ev ,a®ypes ) 44 <br /> [3k HA7ARDOUSWAS[E <br /> (r a oio <br /> OWN <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK .. SINGLE WALL LI 3. SINGLE WALL WTTF: Lj 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> fp��®eyy) EXTERIOR MEMBR NE LINER D95. UNKNOWN _ <br /> 02. DOUBLE WALL ❑4. SIGNLE WALLIN VAULT 099. OTHER <br /> TANK MATERIAL-pnmvy uvk BARE STEEL 3. FIBERGLASS I PLA-MC Lj CONCRETE 95. UNKNOWN 4++ <br /> (paxm®ody) 02. STAINLESS STEEL 04.STEEL CLAD W/FIB:RGLASS O S. FRP COMPTIBLE W/100'/.METHANOL El 99.OTHER <br /> REINFORCED PLASTC(FRP) <br /> TANK MATERIAL_arcmany s Lj 1. BARE STEEL 03. FIBER=S/PL..STIC 0 5. CONCRETE Lj 95. UNKNOWN 443 <br /> (pax:®eery) ❑2. STAINLESS STEEL 0 4.STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTmLE W1100-METHANOL ❑99.OTHER <br /> REINFORCEDPLASTIC(FRP) D I0.COATED STEPS. <br /> 05. CONCRETE <br /> TANK INTERIOR LINING 1.RUBBER LINED LJ 3.EPDXY LINING 0/55.GIASS LLINING95.UNKNOWN 046 DATE INSTALLED wt <br /> OR COATING 0 2 ALKYD LINING 0 4 PHENOLIC LINING ��61JNLINED 0 99 OTHER <br /> (Tia:®rah) (Fa Iml.e aryl <br /> OTHER CORROSION D 1 MANUFACTURED CATHODIC 0 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN 448 DATE INSTALLED 449 <br /> PROTECTIONIFAPPLICABLE PROTECTION . 041MPRESSED CURRENT Cl 99 OTHER <br /> 02 SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEARINSTALLED 45B TYPE(bN ae rah! 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 433 <br /> (O.a+n m+poy) D13PIIS.CONTAINMENT Z31 ALARM 03 FILL TUBE SHUT OFF VALVE <br /> ❑2 DROP TUBE D 2 BALL FLOAT 0 4 EXEMPT <br /> ❑3 STRIKER PLATE <br /> IV.TANK LEAK DETECTION(A4�efrheammM9prep ecw4�tlnmetoolRevd <br /> IF SINGLE WALL TANK rw-appy( 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> (pat--my) <br /> 0 1 VISUAL(EXPOSED PORTION ONLY) D 5 MANUAL TANK GAUGING(MTG) D I VISUAL(SINGLE WALLIN VAULT ONLY) <br /> 0 2 AUTOMA7,CTANK GAUGING(ATG) D 6 VADOSE ZONE D 2 CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3 CONTINUOUS ATG 0 7 GROUNDWATER 0 3 MANUAL MONITORING <br /> 04 STATISTICAL INVENTORY RECONCILIATION 08 TANK TESTING <br /> (SIR) BIENNIALTANKTESTING 0 9 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMA QU OF SUBSTANCE REMAINING 4� TANK FII1.ED WITH INERT MATERIAL' 453 <br /> 7 gallons ❑Yes ❑ No <br /> tr <br /> UPCF(12/99 raised) 10 Formerly SWRCB Form B <br /> v <br />