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LR7FIED PROGRAM CONSOLIDATED - RM lLf <br /> �� N 1lsc>n �I.-) © � ANKS , <br /> UNDERGROUND STORAGE TANKS -TA�PAGE 1 ,05 , rlalk <br /> Fogs ! 01 Z <br /> S. TEMPORARY <br /> TYPE OF ACTION ❑1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) ❑ 7. <br /> PERMANENTLY CE OSED ON SITE <br /> (GaM ons Nam only) 4]0 <br /> CJ 7. RENEWAL PERMIT (Spae!/y Msa+1-Ar INCH uee only) (SpacYy MenW'Mbul Wa ) ❑ B. TANK REMOVED <br /> ] FACILITY IDM <br /> BUSINESS NAME(Sarna n FACILITY NAME ar DBA'DaaN Bu4nsn N) <br /> ro.» Vie: <br /> My Mini Mart 431 <br /> LO CATION WITHIN <br /> ,TE <br /> lOPNanM) C /� <br /> /7J` `.L. DESCRIPTIDN <br /> ,4]2 TANK MANUFACTURER n g 433 COMPARTMENTALIZED plawTAN %XYm ❑ No 474 <br /> TANK 10 s N Yn',complels aro page for eea�comperlmenL <br /> 1 Joor Manufacturing <br /> 4b NUMBER OF COMPARTMENTS p7 <br /> DATE INSTALIAD(YEIUUMO) u5 TANK CAPACITY IN GALLONS O <br /> 5/99 3,000 476 <br /> ADDITIONAL DESCRIPTION(F rAXW un oM'1 <br /> IL TANK'C0RT@1TS <br /> ka <br /> TANK USE 439 PETROLEUM TYPE ❑2. LEADED ❑ 5. JET FUEL <br /> ® 1. MOTOR VEHICLE FUEL �yT❑�I& REGULAR UNLEADED ❑ ] DIESEL ❑ 5.AVIATION FUEL <br /> m <br /> (Ned,m PWO PabcW Type) L'110. PREMIUM UNLEADED <br /> ❑ 2. NOWFUEL PETROLEUM Elie. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER <br /> Cl J. CHEMICAL PRODUCT COMMON NAME(hom NeT4sdaua MIWM lnronlpryPs* N7 CAB 0(hom HwaN Maledels/rnanbrypps) N2 <br /> ❑ 4. HAZARDOUS WASTE(Incbdss <br /> Used OB <br /> ❑95. UNKNOVM111Si <br /> M.TANK CONSTRUCTION <br /> FTYPE OF TANK ❑ 1 SINGLE WALL 113. SINGLE WALL WITH ❑ S. SINGLE WALL WITH INTERNAL BUDDER SYSTEM 44] <br /> EXTERIOR MEMBRANE LINER [195. UNKNOWN <br /> ck one dem WY) 2. DOUBLE WALL ❑ 4, SINGLE WALL IN A VAULT ❑W. OTHER <br /> ❑ . UNKNOWN <br /> TANK MATERIAL prima <br /> - ry lank ❑ 1. BARE STEEL 117. FIBERGLASS/PLASTIC [35. CONCRETE W. OTHER <br /> 444 <br /> (CMM we Nem mN) ❑ 2. STAINLESS STEEL M 4. STEEL CUD ❑ S. FRP COMPATIBLE W/100%METHANOL ❑W. <br /> WIFIBERGLASS <br /> REINFORCED PLASTIC(FRP I <br /> TANK MATERIAL•saoMMY lank❑ 1. BARE STEEL A0 <br /> A55 ]. FIBERGLASS/PLASTIC ❑ B. FRP COMPATIBLE W/100%METHANOL ❑95 UNKNOWN N5 <br /> (CMM me Nom anry) ❑ 2. STAINLESS STEELE'J 4. STEEL CUD W/FIBERGLASS ❑9. FRP NON-CORRODIBLE JACKET ❑99. OTHER <br /> REINFORCED PLASTIC(FRP) ❑10 COATED STEEL <br /> ❑ S, CONCRETE <br /> TANK INTERIOR LINING [31, RUBBER LINED [1 ]. EPDXY LINING C3 S. GLASS LINING [196. UNKNOWN HB DATE INSTALLED 447 <br /> OR COATING ❑ 2.ALKYD LINING ❑ L PHENOLIC LINING $I 8. UNLINED [199. OTHER Farksgl uss <br /> ft <br /> orM Ram DATE INSTALLED M9 <br /> OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ]. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN NB <br /> PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER <br /> (For bell use oMy) <br /> mi <br /> ❑ 2. SACRIFICIAL ANODE 452 <br /> YEAR INSTALLED 450 TYPE(Far bol un o*) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> 1. SPILL CONTAINMENT 1999 Cl 1. ALARM ❑ ]. FILL TUBE SHUT OFF VALVE__ <br /> ❑ 2. BALL FLOAT ❑ 4. EXEMPT <br /> ,a� Z. DROP TUBE 1999 ' <br /> IN ]. STRIKER PLATE 1999 I <br /> IV. TANK LEAK DETECTION <br /> 457 IF DOURER WALL TANK OR TANK WITH BUDDER(CMM one Nem Nlyl: 454 .I <br /> WALL TANK(Chats a1IMI appy): <br /> ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) A❑A 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATO) ❑ e. VADOSE ZONE F9 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ ]. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ ]. MANUAL MONITORING <br /> ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ B. TANK TESTING <br /> BIENNIAL TANK TESTING ❑go. OTHER _ <br /> V.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE _ <br /> ESTIMATED DATE UST USED(YROAO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 45e TANK FILLED WITH INERT MATERIAL? 457 <br /> ONbna G Y" No❑1 No <br /> T SiS l6 l gwoo X Formedy SWRCB Form B <br /> UPCF(7/99) • <br />