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I <br /> I <br /> UNIFIED PROGRAM C0NS01-10ATE Or' ORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> ;Mo oages oer;ank) <br /> i <br /> ) Page � Of <br /> ^PE OF ACTION NEW SITE PERMIT ❑ a AMENCEO PERMIT ❑ 5. CHANGE OF!NFORMATION) ❑ 5. TEMPORARY SITE CLOSURE <br /> ;Checx one,tem only) , <br /> _ ❑ ?. PERMANENTLY CLOSED ON SITE <br /> 'J 3.RENEWAL PERMIT rSoeoty reason-trlocal use only) SPecrycna e-rdr:ocal use on <br /> n4 Nl ❑ 3. TANK REMOVED 430 <br /> 3 Ir�ESS NAME(Same as FACILITY NAME or CBA-Ooing dus,ness Asl FACILITY IDK i I I <br /> AION WTHIN SITE; poonall a3 <br /> I.TANK DESCRIPTION <br /> TANK iO S 'ANK.MANUFACTURER COMPARTMENTALIZED TANK ❑ yes ❑ Nd <br /> f-Y..-.:omlNale Ona sage for each C oartment <br /> OA'E INSTAZ'? <br /> (YEAR/MO) "ANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> 79 <br /> AOOITICN DESCRIPTICN(Forlocal use only) <br /> I.TANK CONTENTS <br /> TANK USE 432DETROLEUM TYPE <br /> ❑ I MOTOR VEHICLE:-U EL ❑ha. REGULAR UNLEADED I ❑ L '_EAOEO ❑ 5. JET FUEL <br /> (If marked.complete Perroleum Type) ❑lGPREMIUM UNLEADED ❑ 1. DIESEL C: 3. AVIATION FUEL <br /> C3 2. VON-FUEL PETRCL=UM ❑ ,,c MIDGRAOE'JNl EAOEO ❑ a GASOHOL a 99. OTHER <br /> ❑ 3. CHEMICAL PRODUCT <br /> ❑ a 'OMMON NAME;hom Hazatdous Materials ime+kcfy pager :AS A(fromHazamous Mafana)s Imwnrory Pagel <br /> HAZARDOUS WAS--(InUudes <br /> Jsed Oil) <br /> 15, JNKNnWN <br /> III.TANK CONSTRUCTION I <br /> I <br /> -yoc OF TANK ❑ 1 SINGLE WALL ❑ 3. SINGLE'NALL MTH ❑ i. 3INGLE'NALL WTH INTERNAL 3LADOER SYSTEM <br /> ;Check ona Item only) ❑ 2. ]OUBLE WALL _XTcRIOR MEMBRANE'_NER ❑95. UNKNOWN <br /> ❑ a, SINGLE'NALL W A'VAUL _;39. OTHER <br /> TANK.MATERIAL-onmary tank ❑ 1. 3ARE STEEL ❑ 3. 9ERGLASS l-_,.S-,IC 71 J 3. CONCRETE a 95. UNKNOWN <br /> iGhecx one,tem only) ❑ 2. STAINL Z-SS STEEL ❑d_ S;EEL CLAO WFISERGLASS ❑ 3. =RP C CMPATIBLE'M10D%METHANOL '.0 99. ]THER <br /> REINFORCED P A571C FRPh <br /> TANK,MATERIAL-secondary tank C3I 3ARE STEEL ❑ 3. -113ERGLASS/Ph-aS7,C ❑ 3. 'RP COMPATIBLE M1100%METHANOL 95. 'JNKNONM <br /> IChecx one Item only) ❑ 2. STAINLESS STEEL ❑ +. STEEL=AO WFI BERGLASS U 9. =RP MCN-CORRODIBLE JACKET '❑99. OTHER <br /> REiNFCRCED PLASTIC;FRP (❑10. C'OATED STEEL <br /> '❑ 3. CONCRETE <br /> TANK!NTERICR LINING <br /> OR COATIN ]ATE INSTALLED <br /> G ❑ RUBBER LINED �-❑ 3. EPDXY LINING ❑ 5. 3LASS LINING ❑35. UNKNCWrM33 <br /> C] 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 3. UNUNED ❑99. OTHER <br /> (heck one Item OnIV) For local use dfkV) <br /> OTHER CORROSION ❑ t MANUFACTURED CATHODIC C13. .=tBERGLASSREINFCRCPA PLASTIC 'J 95. UNKNOWN 434 ]ATE•NST ALLIED <br /> PROTECTION IF APPLICABLE <br /> PROTECTION I ❑ t. :MPRESSED CURRENT ❑99. OTHER <br /> (Checx one item only) ❑ 2, SACRIFICIAL ANODE I For local use WOW <br /> PILL.:ND OVERFILL FEAR INSTAL LED TYPE IFw to'r use anm OVERFILL PROTECTION EQUIPMENT.'EAR INSTALLED <br /> (Ghecx all that apply) ❑ . SPILL CONTAINMENT ❑ t. ALARM ❑ <br /> 1. FILL?LBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ '_ 3ALL=LCAT iJ a. EXEMPT <br /> ❑ 3. STRIKER PLATE I <br /> IV. TANK LEAK DETECTION <br /> F SINGLE WALL TANK,Check all that aoply): :F DOUBLE WALL:ANK OR TANK WITH BLADDER(Ch ch one dem Ohl": <br /> � <br /> I. VISUAL,EXPOSED PORTION ONLY) <br /> 5. MANUAL TANK GAUGING(MTG) 'JISUAL ISINGLE'NALL IN VAULT ONLY)❑ I ❑1 <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 3. VAOOSE ZONE - _ CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ! J 3. MANUAL MONITORING <br /> ❑ a. STATISTICAL INVENTORY RECONCILIATION(SIR), ❑ 3. TANK TESTING <br /> 31ENNIAL TANK:c$TING <br /> I ❑99. -OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED GATE LAST')SED(YR/MO/DAY) _STIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK F11 I PO WTH INERT MATERIAL? <br /> ;allans Yes Vo <br /> CUPAFORM(4/99) Formerly SWRCB Form 8 <br />