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nnn IrAMQnl In ATGn GrIRM /P -;, TANKS UNDERGWND STORAGE TANKS - NK PAGE1(G?�?oe pages per tank) ag of TYPE OF ACTION El NEW SITE PERMIT ❑ 4 AMENDED PERMIT [15 CHANGE OF INFORMATION ❑ 6 TEMPORARY SI E LOS ❑ 7 PERMANENTLY CLOSED ON SITE (Check one item only) ® 3 RENEWAL PERMIT (Specify reason -far local use only) (Specify reason -for local use only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA- Doing Business As) FACILITY ID: 1 3 Beacon Station #3492 LOCATION WITHIN SITE (Optional) 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 # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ® No 434 a 3492-2 (] �p TrUSCO If'Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 435 NUMBER OF COMPARTMENTS 437 12/98 14000 1 ADDITIONAL DESCRIPTION (For lows use only) 438 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL ❑ la, REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If marked complete Petroleum Type) 011a. PREMIUMUNLEADED 03. DIESEL ❑6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM []1c, MIDGRADE UNLEADED ❑ 4. GASOHOL [199. OTHER ❑ 3. CHEMICAL PRODUCT CAS# from Hazardous Materials Inventory page) COMMON NAME (tram Hazardous Materials Inventory page) ( 441 442 ❑ 4. HAZARDOUS WASTE 8006-61-9 (Includes Used Oil) ❑ 95. UNKNOWN III, TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL -primary tank ®1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W/ [199. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL -secondary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE ❑ 99. OTHER REINFORCED PLASTIC (FRP) W1100% METHANOL ❑ S. CONCRETE [110. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [11. RUBBER LINED ❑ 3. EPDXY LINING El5. GLASS LINING [195. UNKNOWN 446 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING t4 6 UNLINED ❑ 99 OTHER (For local use only) (Check one item only) 448 DATE INSTALLED 449 OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER (For lawl use only) (Check one item only) ❑ 2 SACRIFICIAL ANODE 452 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check all ® 1 SPILL CONTAINMENT 1998 ® 1 ALARM ® 3 FILL TUBE SHUT OFF VALVE that apply) ®2 DROP TUBE 199$ ❑ 2 BALL FLOAT ❑ 4 EXEMPT ® 3 STRIKER PLATE 1998 IV. TANK LEAK DETECTION (A description of he monitoring program shall be submitted to the local'.89ency.) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 IF SINGLE WALL TANK (Check all that apply) (Check one item only) ❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (Ml ❑ 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 ❑8TANKTESTING + (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER IV. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED (YR/MO/DAr) REMAINING gallons ❑ Yes ❑ No E UPCF (1/99 revised) • Formerly SWRCB Form B