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`"i 1 JNYFfED PROGRAM CONSOLIDATED t&Mw' < ` U6 TANKS CC UNDERGROUND STORAGE TANKS - TANK PAGE I (Two pages pI�) Page_of_ TYPE OF ACTION ❑ 1.NEW PERMIT ® 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) ❑ 3.RENEWAL PERMIT Equipment Modification ❑ 7.PERMANENTLY CLOSED ON SITE (Specify recon) (specify reawn) ❑ 8.TANK REMOVED BUSINESS NAME(S.as FACILITY NAME or DBA-Dning Business As) 3, FACILITY ID: I' Ahmed s Chevron LOCATION WITHIN SI IE(optimal) - _ %] �E7� 431' I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# °32. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK Yes No 43402� . Unknown If"Yes,"complete one page for each containment DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS 437 (YEAR/MO) Unknown 12,000 1 ADDITIONAL DESCRIPTION(For Imal use rely) 4J9, IL TANK CONTENTS TANK USE 439- PETROLEUM TYPE "a. ® 1. MOTOR VEHICLE FUEL ❑]a. REGULAR UNLEADED / ❑5. JET FUEL (If checked,complete Petroleum Type) ❑Ib PREMIUM UNLEADED ®3. DIESEL [16. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (hem H dms Materials Inventory page) 401 CAS#(tam Hazardous Maarals Inventory page) 442. ❑ 4. HAZARDOUS WASTE (1xmda used oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER [195. UNKNOWN ®2. DOUBLE WALL [14. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primarytent, [11. BARE STEEL [13. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD WNIBERGLASS ®8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ®8. FRP COMPTIBLE W/100%METHANOL 0 95.UNKNOWN ms. (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED 3.EPDXY LINING ❑5.GLASS LINING 95.UNKNOWN a46. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING [14.PHENOLIC LINING ®6.UNLINED [199,OTHER Check one item onl OTHER CORROSION I.MANUFACTURED CATHODIC 3,FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN secs. DATE INSTALLED a4p. PROTECTION PROTECTION [14.IMPRESSED CURRENT [199.OTHER (if Applicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450, TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) ®1.SPILL CONTAINMENT Unknown ❑ 1.ALARM ®3.FILL TUBE SHUT OFF VALVE Unit ®2.DROP TUBE Unknown ❑2.BALL FLOAT ❑4.EXEMPT 10 3,STRIKER PLATE Unknown IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑7.GROUNDWATER [13.MANUAL MONITORING [3 4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING [199. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455_ ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 453. gallant, ❑Yes ❑ No UPCF hwfwrc-b(1/99)-114 http://www.unidocs.org Rev.02/16/00