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UNIFIED PROGRAM CONSOLIDATED FORM y I3 0 3 <br /> . TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 <br /> (two pages per tank) <br /> ,,,d' Page of <br /> TYPE OF ACTION ❑1 NEW SHE PERMIT ❑ 4 AMENDED PERMIT gJ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> (Chink rine item wly) ' \ ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (SNedym n-fmlwaluaemdy) (Speeilyml n-fwlocaluaemdy) ❑ 8 TANK REMOVED 40 <br /> 13USINESS NAME(Su .rACILITYNAME,or DBA-Uourg Business A.aJ FACILITY ID: 1 <br /> USA GASOLINE#3756 <br /> LOCATION WITHIN SITE(OpfimoO 471 <br /> 1.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) <br /> TANK ID 4 432 TANK MANUFACTURER 437 <br /> COMPARTMENTALIZED'1'ANK ❑Yes ® No nn <br /> STIP III complete me page fur each mnapa son <br /> DA'Z'E INSTALLED(YEAR/MO) 435 TANK CAPACITY IN ALLONS n7o NUMBER OF COMPARTMENTS my <br /> G <br /> 1990 10000 <br /> ADDITIONAL DESCRIPTION(Far lout ase only) <br /> 438 <br /> H.TANK CONTENTS <br /> FUwd <br /> K USE 439 PE'TROLLUM"TYPE <br /> ao <br /> MOTOR VEHICLE,Fl1EL ®In. REGULAR UNLEADED ❑2. LEADED <br /> ❑5. JE'T NEL. <br /> pkk Pctrokmn'lype) ❑ Ib. PREMIUMUNLEADED ❑3. DIESEL <br /> FUEL PETROLEUM ❑6. AVIATION 1lJIi1. <br /> ❑le. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER <br /> ICAL PRODUCT COMMON NAME (from Harardou5 MaledoE Inventory <br /> RDOUS WASTE PaBe) 441 CASH(from Ilawdous Mueoab Inventory page) 442 <br /> Oa) <br /> ❑95.UNKNOWN <br /> 11I. TANK CONSTRUCTION <br /> TYPE Oil TANK ❑ L SINGLE WALL ❑3. SINGL I WALL WITH <br /> S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Ch«k.m4 item oNy) EXTERIOR MEMBRANE LINER <br /> 0 9. UNKNOWN <br /> 02 DOUBLE WALL ❑4 SIGNLE WALL IN VAULT 1199. OTHER <br /> 'IANKMATERIAL-prhnaryl :I lel BARE STEEL 3. FIBERGLASS/PLASTIC <br /> (chink one item only) ❑5. CONCRETE 95. UNKNOWN 444 <br /> ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/10016 METHANOL ❑W OTHER <br /> REINFORCED PLASTIC(PEP) <br /> TANK MATERIAL-aewna.ay uadc I. BARE STEEL 3. FIBERGLASS/PLASTIC <br /> (Check one item oNy) 5. CONCRETE❑2. STAINLESS STEEL ®4. STEEL CLAD WA IBERGLASS ❑8. RM 95 UNKNOWN 445 <br /> COMP'nBLE W/11X)6 METHANOL ❑N OTHER <br /> REINFORCEDPLAS'GC(FRP) ❑IQCOATEDSTEEL <br /> ❑5. CONCRETE <br /> 'TANK INTERIOR LINING I.RUDBER LINED 3.EPDXY LINING <br /> 5.GLASS LINING 95.UNKNOWN H DATE INSTALLED 447 <br /> OR COATING ❑2 ALKYD LINING <br /> (Check.son oNy) ❑4PHENOLIC LINING ®6 UNLINED 1199 OTHER <br /> (For local use only) <br /> OTHER CORROSION ❑]MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC <br /> ❑95 UNKNOWN 44a nos <br /> PROTECTION IF APPLICABLE PROTECTION <br /> one RIsrsay) <br /> (Check ❑41MI'RIiSSED Cl1RRRNT ❑99 OTHER <br /> ❑2 SACRIFICIAI.ANODE <br /> SPILL AND OVERFILL YEAR INSTALLED 450 mYJ (F'oNocal uro only) <br /> TYPE(IoaxoN 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Cheek all Nat apply) ®I SPILL CONTAINMENT 1990 <br /> ®2 DROP TUBE 1990 ®1 WARM ❑3 FILL TUBE SIRII'OFT VALVE <br /> ®2 BALL FLOAT ❑4 EXEMPT <br /> ®3 STRIKER PLATE 1990 <br /> 1 V.TANK LEAK DETECTION(A demopfim.Jits,mmamr,program amt W aeouseed to <br /> IF SINGLE WALL TANK(cheekNl Nal apply) the tom agenry)453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> ❑IVISUAL(EXPOSED PORTION ONLY) ❑sMANUAL TANK GAUGING MTG (Chakomitcmmdy) <br /> ATG ( ) C1I VISUAL(SINGLE WALLIN <br /> LHON ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING <br /> (ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING ❑3 MANUAL MONITORING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAy) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 <br /> TANK FILLED WITH INERT MATERIAL, 459 <br /> gallons <br /> ❑Yes ❑ No <br /> UPCF(1/99 revised) <br /> Formerly SWRCB Form B <br />