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/---") 0 Gill-, UNIFIED PROGRAM (UP) FORM /If 0'7 k Q UNDERGROUND STORAGE TANKS - TANK PAGE 1 two r tank Pae of TYPE OF ACTION 01.NEW SITE PERMIT 03.RENEWAL PERMIT 0 5.CHANGE OF INFORMATION 0 TPERMANENTLY CLOSED SITE (Check ore Item only) 0 2.INTERIM PERMIT 4.AMENDED PERMIT 0&TEMPORARY SITE CLOSURE 0 8.TANK REMOVED 490 BUSINESS NAME(same as FACILITY NAME or oeA) FACILITY ID: t 3 Tesoro West Coast Company,LLC USA,CC#88222 LOCATION WITHIN SITE(optional) 491 I. TANK DESCRIPTION A scaled plot plan with locations of UST system(s)including buildings and landmarks shall be submitted to the CUPA or PA. TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK 0 Yes 0 No 494 b MODERN WELDING If'Yes',complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 438 NUMBER OF COMPARTMENTS 437 UKN 12,000 ADDITIONAL DESCRIPTION(For local use only) 496 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL 0 Ia. REGULAR UNLEADED [12. LEADED 0 5. JET FUEL (If marked cormlate Petroleum Type) 01b. PREMIUM UNLEADED 03. DIESEL 06. AVIATION FUEL 0 2. NON-FUEL PETROLEUM 0 1c. MIDGRADE UNLEADED 0 4. GASOHOL 0 99.OTHER: 0 3. CHEMICAL PRODUCT COMMON NAME 441 CAS# 442 (from Hazardous Materials Inventory page) (tom Hazardous Materials Inventory page) 0 4. HAZARDOUS WASTE(includes Used Oil) 0 95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK El 1. SINGLE WALL 0 3. SINGLE WALL WITH 5. SINGLE WALL WITH INTERNAL BLADDER ((Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 443 0 2. DOUBLE WALL [:14. SIGNLE WALL IN VAULT [199. OTHER TANK MATERIAL-primary tank ®1. BARE STEEL 3. FIBERGLASS/PLASTIC 05. CONCRETE 095. UNKNOWN ((Chad,one item only) 0 2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS [18. FRP COMPTIBLE W/100%METHANOL [199.OTHER 444 REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank 0 1. BARE STEEL 03. FIBERGLASS/PLASTIC 0 5. CONCRETE [195. UNKNOWN ((Check one item only) 0 2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 08. FRP COMPTIBLE W/100%METHANOL[199.OTHER 445 REINFORCED PLASTIC(FRP) 0 10.COATED STEEL TANK INTERIOR LINING 1.RUBBER LINED 0 3.EPDXY LINING 0 5.GLASS LINING 0 95.UNKNOWN DATE INSTALLED 447 OR COATING 0 2 ALKYD LINING 0 4 PHENOLIC LINING 0 6 UNLINED 0 99 OTHER 446 (For local use only) (Check one item only) OTHER CORROSION 0 1 MANUFACTURED CATHODIC 3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN DATE INSTALLED 44a PROTECTION(IF APPLICABLE) PROTECTION Cl 4 IMPRESSED CURRENT 0 99 OTHER 448 (For local use only) Check one item only) 0 2 SACRIFICIAL ANODE SPILL AND OVERFILL (Check all that apply) YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 0 1 SPILL CONTAINMENT 0 1 ALARM 0 2 DROP TUBE 0 2 BALL FLOAT ® 3 STRIKER PLATE 0 3 FILL TUBE SHUT OFF VALVE 0 4 EXEMPT IV. TANK LEAK DETECTION(A description of the monitoring program shell 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 we Item only) 0 1 VISUAL(EXPOSED PORTION ONLY) 0 5 MANUAL TANK GAUGING(MTG) 0 1 VISUAL(SINGLE WALL IN VAULT ONLY) 0 2 AUTOMATIC TANK GAUGING(ATG) 0 6 VADOSE ZONE 0 2 CONTINUOUS INTERSTITIAL MONITORING 0 3 CONTINUOUS ATG 0 7 GROUNDWATER 0 3 MANUAL MONITORING 0 4 STATISTICAL INVENTORY RECONCILIATION 0 8 TANK TESTING (SIR) +BIENNIAL TANK TESTING 0 99 OTHER V.TANK CLOSURE INFORMATION /PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 O Yes 0 No OFFICIAL USE ONLY DATE RECEIVED CUPA PA DISTRICT/INSPECTOR UP FORM(1/2000 Version) 1 Formerly SWRCB Form B SBC UST-B.doc