Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> I TANKS <br /> UNDERGROUND STORAGE TANKS-TANK PAGE 7 <br /> �(Nw �t k) 1 <br /> b <br /> Pa9. <br /> TYPE OF ACTICN ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ S. TEMP SITE CLOSURE <br /> (CAeok om iMm Dory) ❑ 1. PERMANENTLY CLOSED ON SITE <br /> ❑].RENEWAL PERMIT I]pciry maon.lorbcal vee oM7 (SP.,y h-N--Afllwal uae pmy) ❑ a. TANK REMOVED 400 \ <br /> BUSINESS NAME(S...as FACILITY NAME w OBA-MIN Bua sss Aa) FACILITY IDI <br /> JAC( �<<. .CtG GG o�oa�f�� -� TF}0515555 �o <br /> TWTSITE(Op p C j / qt C CA .. <br /> /7, 5 1.TANK DESCRIPTION <br /> TANK ID/ TANKMANUFACTURER COMPARTMENTALIZEDTANK Yes ❑ No <br /> foU <br /> T 11'Yei,complete we PINS Iw Ma wmpanmanL <br /> GATE INSTALLED(YEARIMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> �d o � ✓, / <br /> ADDITIONAL DESCRIPTION(Fwb I.ee oNy) VI IU <br /> II.TANK CONTENTS '1 <br /> =FUELO <br /> NK USE 4]2 PETROLEUM TYPE 17C(` 1 4 2 <br /> VEHICLE FUEL ❑is REGULAR UNLEADED ❑ 2. LEAOEO C�lJJ''L QJUEL <br /> bb PefmMum Type) 10. PREMIUM UNLEADED ❑ ] DIESEL ❑�,T�yE�-jEA�Th <br /> EL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑ 4. GASOHOL <br /> LPRODUCT COMMON NAME(Imm Hualloui lLMM1nLS InwKorypape) rypage) <br /> OUS WASTE(IntluMa <br /> Ill.TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1, SI HOLE WALL ❑ 0. SINGLEWALLWITH ❑ 5. SINGLE WALL'MTH INTERNAL BLADDER SYSTEM <br /> EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> (CMck oM nem wry) 2. DOUBLE WALL <br /> ❑ A. SINGLE WALLAH A VAULT ❑99 OTHE0. <br /> TANK MATERIAL-pdmary MnA V1 9ARE STEEL ❑ ]. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 095. UNKNOWN <br /> (CAeck.d....w ❑ 2 STAINLESS STEEL 04. STEEL CLAD WIFISERGLASS ❑ B. FRP COMPATIBLE WI1M%METHANOL ❑99. OTHER <br /> REINFORCED PLASTIC IFRP) <br /> TANK MATERIAL-s Mary Wk ❑ 1 BARE STEEL ]. FIBERGLASSIPLASTIC ❑ B. FRP COMPATIBLE W1100%METHANOL 095. UNKNOWN <br /> (Cneck orre dem Doty) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9 FRP NOH�CORROOIBLE JACKET 099. OTHER <br /> REINFORCED PLASTIC(FRP) 010 COATED STEEL <br /> ❑ 5. CONCRETE <br /> TANK INTERIOR LININGDATE INSTALLED <br /> OR COATING ❑ 1. RUBBER LINED ❑ ]. EPDXY LINING ❑ 5. GLASS LINING 095. UNIWOWN4]] <br /> ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ e. UNLINED ❑99. OTHER Forlmal uae wI) <br /> IDlwck oro Mm pn ) DATE INSTALLED <br /> OTHERCORROSION ❑ 1. MANUFACTURED CATHODIC ❑ ]. FIBERGLASS REINFORCEO PLASTIC ❑95. UNKNOWN 04 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Fw kau/me wryl <br /> (Cnac4 oru nem wry) ❑ 2. SACRIFICIALANOOE <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forbcal me Dory) OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED <br /> (OAecka/Nalapply) 1. SPILL CONTAINMENT 1.ALARM ]. FILL TUBE SHUT OFF VALVE__ <br /> 2. DROPTUBE ❑ 2. BALL FLOAT ❑ A EXEMPT <br /> ]. STRIKER PLATE <br /> - 4.TANK LEAK DETECDON <br /> iF amcLe wALL TAxK n.oA as mala IFOOUBLEWALLTANKORTANKWITNBLADDER <br /> ❑ 1. VISUAL(fJLPOSED PORTION ONLY) C) 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> 2. AUTOMATIC TANK GAUGING(ATG) ❑ a. VAOOSEZONE 2. CONTINUOUS INTERSTITIAL MONITORING <br /> ❑ ]. CGNTINUOUSATG ❑ T. GROUNDWATER ❑ ]. MANUALMONITORING <br /> ❑ 4. STATISTICALINVENTORY RECONCILIATION(SIR). ❑ 9. TANKTESTING <br /> BIENNIALTANK TESTING ❑99. OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YRIMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING US TANK FILLED WITH INERT MATERIAL <br /> 9�ns ❑Yu ❑No <br /> Formerly SWRCB FORD B <br /> CUPAFORM(4199) .- , <br />