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e UNIFIED PROGRAM CONSOLIDATED FORM <br /> g'/2 V z&l TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 7 <br /> ,&D 967P�Nro pages per tank) <br /> Page _ of <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE <br /> (Checkom Semonly) ❑ T. PERMANENTLY CLOSED ON SITE <br /> ❑3.RENEWAL PERMIT (Spodtyvason-rorbul use my) (Speciy chanya-/orlocal use only) ❑ e. TANK REMOVED 430 <br /> BUSINESS NAME(Sam es FACILITY NAME or DBA-Doing Business As) FACILITY IDA 1 <br /> R2CO Q U D <br /> LOCATION aTESqPN.m0 431 C <br /> VrANK DESCRIPTION <br /> TANK ID# TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yea ANO <br /> 17yofJ/J If'Yea,complete one page fax eacr withparbilent. <br /> DATEINSTALLED(YEA 0) TANK CAPACITY IN GALLONS [•v C`� �(/f= NUMBER OF COMPARTMENTS <br /> ADDITIONAL DESCRI ION(Fdrlocal use OMy) <br /> IL TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> y".111- <br /> egMO TOR VEHICLE FUEL Ella. REGULAR UNLEADED ❑ 2. LEADED ❑ S. JET FUEL <br /> IIm complete Pefmlaum Type) ❑lb. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATIONFUEL <br /> ❑ 2. NON-FUEL PETROLEUM �lc MIDGMDE UNLEADED ❑ 4. GASOHOL ❑99. OTHER <br /> ❑ 3. CHEMICAL PRODUCT 1�' <br /> ❑ 4. HAZARDOUS WASTE(Indudea COMMON NAME rymm Hazardous Mafadala Inrentorypage) CAB#(Imm Hazardaua Mafedals Inrenforywpa) <br /> Used 00 <br /> El 95 UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> (Check ane item only) 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> • ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER <br /> TANK MATERIAL-primary tank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 1195. UNKNOWN <br /> (Check mlalrem oMy) ❑ 2. STAINLESS STEEL N�d. STEEL CUD WIFIBERGUSS ❑ 0. FRP COMPATIBLE Wil W%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-aawndary tank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ e. FRP COMPATIBLE W1100%METHANOL ❑95. UNKNOWN <br /> (Checkom ilemonyJ <br /> ) ❑ 2. STAINLESS STEEL b4. STEEL CUD WIFIBERGUSS ❑ 9. FRP NON-CORRODIBLE JACKET El N. OTHER <br /> REINFORCED PLASTIC(FRP) ❑10. COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING ❑ 1, RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 DATE INSTALLED <br /> OR COATINGy� <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING - UNLINED ❑99. OTHER <br /> (Check oft item o ) Forbcel vee aril) <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC 3. FIBERGUSS REINFORCED PLASTIC ❑95. UNKNOWN 434 DATEINSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> 04. IMPRESSED CURRENT ❑99. OTHER <br /> (Gwck one Hem any) ❑ 2. SACRIFICIAL ANODE (Forlwal use any) <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Chacka.fhafapPly) ❑ 1. SPILLCONTAINMENT oQ ❑ 1. ALARM 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE �-f 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> .:IV.TANK LEAK DETECTION <br /> IF SINGLE WALL UNKChedaN that. : IF DOUBLE WALL TANK OR TANK WITH BUDDERCmak one Item only): <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) �❑ 11. VISUAL ISINGLE WALLIN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSEZONE I�F.3. CONTINUOUS INTERSTITIALMONITORING <br /> ❑ 3. CONTINUOUSATG - ❑ T. GROUNDWATER ❑ 3. MANUAL MONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ S. TANK TESTING _ <br /> BIENNIAL TANK TESTING 099. OTHER <br /> V.TANK'CLO SURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLEDVATH INERT MATERIAL? <br /> gallons ❑Yes ❑No <br /> CUPAFORM(4/99) • • Formerly SWRCB Form 8 <br />