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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK/SS-TANK PAGE 7 TANKS <br /> (Ixo paD I ) <br /> WPEOFACTION 1.NEW SITE PERMIT D a.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION / 2 <br /> (G+ck.demary-) / ❑ B. PERMANENTLY <br /> CLOSEDCLOSON ( J <br /> ❑J.RENEWAL PERMIT ❑ T. PERMANENTLY CLOSED ON SI TE <br /> (SpaGry noon-/abcalvfe amyl (Sperry cMnpa-/o/bul uae eMy) ❑ A, TANK REMOVED aJ0 <br /> BUSINESS NAME(Same of FACILITY NAME a DBA-OaYlp Susirnfs As) 0 _C ` FAGLITY ID/ <br /> LOCATIONVYI IN SITE(Op9onaQ AJt <br /> - <br /> TANK ID• / TANK MANUFACTURER I.TANK DESCRIPTION <br /> 1 T �SIS(o ls' COMPARTMENTALIZED TANK ❑ Yes ❑ No <br /> II'Yef-,wmplale one Dape fa earn canpaHmenl. <br /> OATE INSTALLED(YEARIMO) TANK CAPACITY IN GALLONS NUMDER OF COMPARTMENTS <br /> ADDITIONAL DESCRIPTION(Fabcal m+oNy) ' <br /> II.TANK CONTENTS <br /> TANKUSE 432 PETROLEUM TYPE <br /> ❑-.1. MOTOR VEHICLE FUEL ❑Is. REGULAR UNLEADED ❑ Z. LEADED C15. JET FUEL <br /> .�(d maMaO,conylale Pelraeum Type) Ir, PREMIUM UNLEADED ❑ ]. DIESEL ❑ 8. AVIATION FUEL \/ <br /> ]. NON-FUEL PETROLEUM A )C MIDGRADE UNLEADED ❑ d. GASOHOL1:199. <br /> ❑ ]. CHEMIGLPRODUCT ' <br /> OTHER_ <br /> ❑ k. HAZARDOUS WASTE(IaJWes COMMON NAME(ram Hataltlnous Malenals Imanlorypape) s GS I pnm Hatanlew Maledals IrIvvwwp.,a) <br /> Ulad Od) <br /> �S <br /> III.TANK CONSTR TION <br /> TYPE OF TANK SINGLE WALL ❑ J. SINGLE WALL VATH ❑ 5. SINGLE WALL WITH INTERNAL BUDDER SYSTEM <br /> (CMck om dem aNy) ❑ ]. DOUBLE WALL EXTERIOR MEMBRANE LINER �95. UNKNOWN <br /> ❑ a. SINGLE WALL IN A VAULT ❑89. OTHER <br /> TANK MATERIAL-p+imary un4 p/� BARE STEEL ❑ J. FIBERGLASSIPIASTIC <br /> ✓ - C35, CONCRETE 1195. UNKNOWN <br /> (CMckeM dem pray) ❑ Z STAINLESS STEEL ❑ K. STEEL CLAD WIFIBERGUSS ❑ S. FRPCOMPATIBLEWl100%METHANOL 099. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANKAIATERAL.sanMaryuuk 1:1 1. BARE STEEL ❑ 0. FIBERGLASSIPUSTIO ❑ 8. FRP COMPATIBLE W I00%METHANOL 09. UNKNOWN <br /> (Crack.dem"Y, ❑ Z. STAINLESS STEEL ❑ a. STEEL CLADW/FIBERGLASS ❑ 9. FRP MON.CORROOIBLE JACKET 00. OTHER <br /> REINFORCED PLASTIC(FRP) 0 10. COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LINING ❑ 1 RUBBER LINED ❑ J. EPDXY LINING ❑ 5. CUSS LINING ❑95. UNKNONMaJ] DATE INSTALLED <br /> OR COATING � v <br /> (Crack om demo ) 0 Z. ALKYD LINING ❑ d. PHENOLIC LINING 1.�UNLINED 099. OTHER <br /> (Fa kKar vas <br /> OTHER TION IF PP 1 MANUFACTURED CATHODIC ❑ J. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN a]d MTEINSTALLED <br /> PROTECTION IF APPLICABLE <br /> PROTECTION 13 a IMPRESSED CURRENT <br /> (Geck one dem eNy) ❑88. OTHER <br /> ❑ Z. SACRIFICIAL ANODE (Fabcal vse only) <br /> SPILLANDOVERFILL YEAR INSTALLED TYPE(Fpr KK+l uss Dray) OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED <br /> (CNck ak lMl apply) ❑ 1. SPILL CONTAINMENT <br /> ❑ 1. ALARM Q J. FILL TUBE SHUT OFF VALVE_ <br /> ❑ 3. DROP TUBE ❑ 3. BALL FLOAT ❑ K, EXEMPT <br /> ❑ J. STRIKER PLATE <br /> W. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK(Crecka9lM(aP J: IF DOUBLE WALL TANK 00.TANK WITH BLADDER kone dem only); <br /> ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLINVAULTONLY) <br /> 13 t. AUTOMATIC TANK GAUGING(ATG) ❑ 0. VALK)GLZOIIL ❑ 7. CUNIINUWSINt LRu IIIIALMUHIIORn/G <br /> ❑ J. CONTINUOUSATG ❑ T. GROUNDWATER ❑ J, I.ANUAL MONITORING <br /> ❑ a. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 0. TANK TESTING <br /> BIENNML TANK TESTING 1:3 99, OTHER <br /> V.TANK CLOSURE INFORMATONIPERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE UST USED D'RIMOA)AY) ESTIMAT NKCL SUREISUBNTMAC NI DEININGRMA +35 TANK FILLED WITH INERT MATERIAL? <br /> D090nf <br /> ❑Yee ❑No <br /> (:�D 1'�/y141 <br /> CUPAFORM(4/99) NOW -.99( <br /> Formerly SWRCB Form 0 <br />