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FROM : J. Schetter PHONE NO. : 5306667692 Dec. 02 2005 02:46PM P5 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS- TANK PAGE l (Two pages per tank) Page 1 of 2- TYPE OP ACTION ❑ 1,NEW PERMIT ❑ 4.AMENDED PERMIT ® 5,CHANGE OF INFORMATION ❑ 6.ThMPORARY TANK CLOSURE 430. (Check une item only) ❑ 3.RENEWAL PERMIT . ...... _updated info_mluesi [3 7,PERMANENTLY CL.()SFD ON SITE (Specify reeton) (Specify r0awn) ❑ 8.TANK REMOVED BUSINESS NAME(Same is FACILITY NAME oc DgA-Duinyt Business As) 3 FA(A l..1TY ID- 1. Arno Facility No. 00595 LOCATION WITHIN SITE(optioaan 43l L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including WildigR and landmarks shall be submitted to the local agency.) TAN K ID# 431. TANK MAM MANUFACTURER 433 COMPARTE -NTALI D TANK Ycs ® No 434. 2-UNL XERXES 1C"Yore comp ete one Doge fhr rich q n prrtmcnt, DATE INSTALI..ED 435. TANK CAPACITY IN GALLONS 430. NUMBER OF COMPARTMENTS MAWMO) 437. 12/01/1984 12,000 1 ADDITIONAL DESCRIPTION(Por ioc t,.K(=,ly) 439_ 11.TANK CONTENTS TANK USE 439. PP,TROLEUM TYPE 440. ® 1. MOTOR VEHICLE NEL ®1a REGULAR UNLEADED ❑2. LFADED ❑3. I>T FUEL. (If e=lw4,"view PeWlmmType) ❑Ib. PRUhffLTMUNLEADED C1 3. DIFSPI, ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM 0 1u, MIDGRADE UNL ExDED Q 4. GASOHOL ❑99,OTHER: _ ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Ha]4rdcws MacAa(a 1m nlury page) 441. CASK(from Hnmrdoua M4terutg)nvent0ry Dake) 442. ❑ 4. HAZARDOUS WASTE GASOLINE 8006-61-9 (Includes Used Oil) ❑ 95.1INKNOWN 111.TANK CONSTRUCTION TYPF OF TANK ❑1 SINGLE WALL 3. SINGLE WALL WITH EXTERIOR ❑5. SINGI,F WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN 02 DOUBLE WALL ❑4. SINGLE WAI I.IN A VAULT ❑99. OTHER TANK MATERIAL primary i4n1< 01. BARE STEEL 03, FIBERGLASS/PLASTIC 5 CONCRETE ❑95.UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL [714. STEFI.CLAD W/FIBERGLASS [718. FRP COMPAT1.67,E ❑99.OTHER: REINFORCED PLASTIC(FRP) W/tW%METHANOL TANK MATERIAL-secondary tsnk 1. DARE STEEL N 3. FIBERGLASS/Pt.AS"I'IC ❑S. FRP COMPTIBLE W/L00%METHANOL, Ej 95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEL ❑4. STEEL.CLAD W/FIBERGLASS [39. FRP NON-CORRODATif.r.JACKET ❑99.OTHER REINFORCED PI.ABTI(`.(FRP) Q 10. COATED STEEL 5. CONCRETE TANK INTERIOR LINING I RUBBER LINED t13.EPDXY LtNINCt (]5.GLASS LINING 95.UNKNOWN 440, DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ®6.UNI-INED Q 99.OTHER Check one item only) CVrALR CORROSION 1.MANUTACTURED CATHODIC I FIBERGLASS RErWORCF.D PLASTIC 95.UNKNOWN 449. DATE rNSTAI.I.F.T) 440 PROTECTION PROTECTION []4.DRESSED CURRENT ❑99.OTHER (IPA licablc) 2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450, TYPE 451. OVERFILL PROTECTION FQUIPME'NT: YEAR INSTALLED 452. (Check all that apply) N 1,SPILL CY)NTAINMENT _2004 OPW_ ®1.ALARM 2004 El 3.F4.1:TU.EW SHUT OFF VALVE N 2.DROPTU13T3 _2004 OPW ..., ®2.BALL FLOAT 2004 ❑4.ExLMlrl- N 3.STRIKER PLArh 1999 OPW IV.TANK LEAK DETECTION (A description of the monitoring program shall be Submitted to the local agency.) IF SINGLE WALL.,TANK 453. IF DOUBIZ WALL TANK OR TANK WITH BLADDER 4z4 (Check all that apply) (Cheek one item only) ❑1. VISUAL(EXPOSED PORTION ONLY) Q 5.MANUAL TANK GA001NG(M'I'G) ❑1,VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GALiorNG(ATG) ❑6.VADOSE ZONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG Q 7.GROl3NDWATGR ❑3.MANUAL.MONITORINQ [3 4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)(•BIENNIAL TANK TF.STTNG ❑99. OTIIER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455' ESTIMATED QUANTITY OF SUBSTANCE REMALNINC 450 -I-ANK FILLED WITH iNRRT MATERIAL? 457 gallons ❑YOs ❑ No