Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> TAN <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 ®LI�o <br /> �7 (hero pages fpertank) <br /> O` Page _ of _ <br /> ❑ 5. CHANGE OF INFORMATION) ❑ 8.TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ T. PERMANENTLY CLOSED ON SITE <br /> (Check ane itemDory) <br /> ❑3.RENEWAL PERMIT (Speyrsasan-larkaal uae oNy) (Spaaiy change-brhax/uas onM ❑ B.TANK REMOVED 430 0 <br /> BUSINESS NAME(Samas fACIUTY NAME ar DBA-Doing Bualnaas Aa) <br /> e <br /> FACILITY ID A <br /> LOCATION WITHINSITEIO '!he'p ✓ Q <br /> 1.TANK DESCRIPTION ❑ Na <br /> TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yea <br /> TANK ID Y II'Yea,complete one page br each-mpalpnent. <br /> DA EINSTALTANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> L 0 O) -5-(Y�tti/)_ <br /> ' ADDITIONAL DESCRIPTION(Forlxal uae a*) <br /> 11.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE ❑ 5. JET FUEL <br /> ❑ta. REGU ❑ 2. LEADED <br /> ❑ 1.MOTOR VEHICLE FUEL TARUNLEADED ❑ 3DIESEL ❑ AVIATION FUEL <br /> (It rnaMod,campleM Pafmbum Type) lb. .. PREMIUMUNLEADED 09 <br /> 9. OTHER <br /> ❑ 2. NON-FUELPETROLEUM ❑1c. MIOGRADE UNLEADED ❑ 4. GASOHOL <br /> ❑ 3.CHEMICALPRODUCTDA$M(Imm Nazalloua Mafaliels lnvenforypage) <br /> COMMON NAME(Imm Mazanlous Materials Invenfarypepa) <br /> ❑ 4. HAZARDOUS WASTE 0hesudes <br /> Used Uo <br /> 111.TANK CONSTRUCTION <br /> TYPEOFTANK - ❑ 1. SINGLEWALL ❑ 3. SINGLEWALLVATH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER ❑85. UNKNOWN <br /> (Check one item only) ❑ 2. DOUBLEWALL ❑ q SINGLE WALL IN A VAULT 1399. OTHER <br /> TANK MATERIAL hpnmery tank ❑ 1 SARE STEEL <br /> ❑ 3. FIBERGIASS/PLASTIC ❑ 5. CONCRETE 095. UNKNOWN <br /> (Chem ite <br /> ckam anM ❑ Z. STAINLESS <br /> STEEL ❑ 4. STEEL CLAD WIFIBERGlAS3 ❑ B. FRP COMPATIBLE W1100%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(F <br /> TANK MATERIAL-secondary tank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE W/10094 METHANOL ❑95. UNKNOWN <br /> co <br /> ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑99. OTHER <br /> (Check one sem Dory) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) <br /> ❑10. COATED STEEL <br /> ❑ 5.CONCRETE DATE INSTALLED <br /> TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 <br /> ORCOATING ❑ 4. PHENOLIC LINING ❑ 8. UNLINED N. OTHER (Forlocaluseon <br /> ❑ 2. ALKYD LINING DATEINSTALLED <br /> (Check om item on ) <br /> OTHER CORROSION ❑ 1,MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 <br /> PROTECTION IF APPUCABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER___ (Forlacal use oriry7 <br /> (Check om item ohw ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocel uae only) <br /> (Check 89 that apply) ❑ 1 SPILL CONTAINMENT ❑ 1. ALARM - ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALL FLOAT__ ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> '- FV TANK'LEAK DETECTION. E T <br /> IF DOUBLE WALL TANK ORTANK WITH BLADDER Check ane it.,,Dory): <br /> IF SINGLE WALL TANK Check a0lM1af aper): <br /> El s, MANUAL TANK GAUGING(MTC) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUS INTERSTmALMONITORING ' <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 8. VADOSE ZONE <br /> ❑ 3. CONTINUOUS ATG <br /> El 7. GROUNDWATER ❑ 3. MANUAL MONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ S. TANKTESTING <br /> BIENNIAL TANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRAAOIDAY) <br /> ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLEDW/TH INERT MATERIAL? <br /> gallons ❑Yea ❑Na <br /> Formerly SWRCB Form B <br /> CUPAFORM(4/99) <br />