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UIVIrlt1J rKvljKAIVl L_UIV0VL1lI I Cu rUrtivl U\ TANKS UNDERAPbUND STORAGE TANKS -- *K PAGE 1 ( uL (two pages per tank) Page _ of _ TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ® 3 RENEWAL PERMIT (Specify reason -for local use only) (Specify reason -for local use only) ❑ 8 TANK REMOVED 430 USINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) BF FACILITY IQ: 1 Beacon Station #3492 3 Tpt O © C2 (-� fl LOCATION WITHIN SITE (optional) 431 I. TANK DESCRIPTION (A scaled plat plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID # tp 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK (] Yes ® No 434 3492-2 TAoQ Trusco If "Yes', complete one page for each compartment. DATE INSTALLED (YEARIMO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 12198 14000 1 ADDITIONAL DESCRIPTION (For local use only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 44C 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑ 2. LEADED [35. JET FUEL If marked complete Petroleum Type) ® III PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER [13. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page) 442 ❑ 4. HAZARDOUS WASTE 8006-61-9 (Includes Used Oil) ❑ 95. UNKNOWN Ill. TANK CONSTRUCTION TYPE OF TANK Ell. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [195. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL -primary tank ® 1. BARE STEEL [13. FIBERGLASS / PLASTIC El5. CONCRETE [:195. UNKNOWN 444 (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRF COMPATIBLE WI ❑ 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL-secondarytank ❑ 1. BARE STEEL 3. FIBERGLASS /PLASTIC Cl 5. CONCRETE [195, UNKNOWN 445 (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 8. FRP COMPATIBLE ❑ 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL ❑ 5. CONCRETE ❑ 10. COATED STEEL TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑i 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING Z 6 UNLINED ❑ 99 OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT D 99 OTHER (Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ® 1 SPILL CONTAINMENT 1998 ® I ALARM ❑ 3 FILL TUBE SHUT OFF VALVE that apply} ® 2 DROP TUBE 1998 ❑ 2 BALL FLOAT ❑ 4 EXEMPT ® 3 STRIKER PLATE 1998 IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency-} IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one iters 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 ❑ 3 MANUAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [:199 OTHER IV. TANK CLOSURE INFORMATION ! PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YRIMOIDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 458457 TANK FILLED WITH INERT MATERIAL? REMAINING gallons ® Yes d No UPCF (1/99 revised) Formerly SWRCB Form B