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UNIFIED PROGRAM (UP) FORM <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> two packes Dertank Pae of <br /> TYPE OF ACTION 01.NEW SITE PERMIT 03.RENEWAL PERMIT 0 5.CHANGE OF INFORMATION 0 TPERMANENTLY CLOSED SITE <br /> (Check one Rem only) [12.INTERIM PERMIT V-4.AMENDED PERMIT 0&TEMPORARY SITE CLOSURE 0 8.TANK REMOVED 43o <br /> BUSINESS NAME(So.as FACILITY NAME O DBA) 3 FACILITY ID: <br /> Tesoro West Coast Company,LLC USA,CC#68222 q 30 <br /> a31 <br /> LOCATION WITHIN SITE(optional) <br /> I. TANK DESCRIPTION <br /> A scaled plot plan with locationsof UST system(s)Includingbuildings and landmarks shall be submitted to the CUT or <br /> PA. <br /> TANK ID#�1 4� TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes No AIM <br /> (0 MODERN WELDING H°Yes'.complete one page for each wmpenment. <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 <br /> UKN 8,000 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> It. TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ®1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED 0 2. LEADED 0 5. JET FUEL <br /> (M marked complete Petroleum Type) 01b. PREMIUM UNLEADED 03. DIESEL 06. AVIATION FUEL <br /> 0 2. NON-FUEL PETROLEUM 0 1c. MIDGRADE UNLEADED 0 4. GASOHOL ❑99.OTHER: <br /> 0 3. CHEMICAL PRODUCT COMMON NAME 441 CAS# 442 <br /> (from Harardous Materiels Inventory page) (from Haosmous Materiels Inventory page) <br /> 0 4. HAZARDOUS WASTE(Includes used OIL) <br /> 0 95.UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK 0 1. SINGLE WALL 0 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER <br /> ((Chad,one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 443 <br /> ®2. DOUBLE WALL 04. SIGNLE WALL IN VAULT 0 99. OTHER <br /> TANK MATERIAL-primary tank ®1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN <br /> (Check one item only) 0 2. STAINLESS STEEL 0 4. STEEL CLAD W/FIBERGLASS 0 8. FRP COMPTIBLE W/100%METHANOL 0 99.OTHER 444 <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-secondary lank 0 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN <br /> ((Check one item only) 0 2. STAINLESS STEEL 04. STEEL CLAD W/FIBERGLASS 08. FRP COMPTIBLE W/100%METHANOL 099.OTHER 445 <br /> REINFORCED PLASTIC(FRP) 0 10.COATED STEEL <br /> TANK INTERIOR LINING 0 1.RUBBER LINED 0 3.EPDXY LINING 0 5.GLASS LINING 0 95.UNKNOWN DATE INSTALLED 447 <br /> OR COATING 0 2 ALKYD LINING 0 4 PHENOLIC LINING 0 6 UNLINED 0 99 OTHER 446 (Fo local use only) <br /> (Check oro Item only) <br /> OTHER CORROSION 0 1 MANUFACTURED CATHODIC 0 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN DATE INSTALLED 448 <br /> PROTECTION(IF APPLICABLE) PROTECTION 0 4 IMPRESSED CURRENT 0 99 OTHER : 448 (For local use only) <br /> Cheri,one item only) 0 2 SACRIFICIAL ANODE <br /> SPILL AND OVERFILL <br /> (Chea all Mat apply) YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 <br /> 0 1 SPILL CONTAINMENT 0 1 ALARM <br /> ® 2 DROP TUBE 0 2 BALL FLOAT <br /> 0 3 STRIKER PLATE 0 3 FILL TUBE SHUT OFF VALVE 0 4 EXEMPT <br /> IV. TANK LEAK DETECTION(A description of the monitoring program shell be submitted to the local agency.) <br /> IF SINGLE WALL TANK(Check all mat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> (Chea one item only) <br /> 0 1 VISUAL(EXPOSED PORTION ONLY) 0 5 MANUAL TANK GAUGING(MTG) 0 1 VISUAL(SINGLE WALL IN VAULT ONLY) <br /> 0 2 AUTOMATIC TANK GAUGING(ATG) 0 6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3 CONTINUOUS ATG 0 7 GROUNDWATER 0 3 MANUAL MONITORING <br /> 0 4 STATISTICAL INVENTORY RECONCILIATION 0 8 TANK TESTING <br /> (SIR) -BIENNIAL TANK TESTING 099 OTHER <br /> V. TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAV) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> 0 Yes 0 No <br /> OFFICIAL USE ONLY DATE RECEIVED CUPA PA DISTRICT/INSPECTOR <br /> UP FORM(1/2000 Version) 1 Formerly SWRCB Form B <br /> SBC UST-B.doc <br />