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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (ten pages per tank) <br /> Page _ at _ <br /> TYPEOFACTION 131.NEW SITE PERMIT D 4. AMENDED PERMIT D 5. CHANGE OF INFORMATION) D B. TEMPORARYSITECLOSURE <br /> (Check..Mm only) 13 ?. PERMANENTLY CLOSED ON BtTF _ <br /> 113.RENEWAL PERMIT (Speary naaon-brtwlum any) (Specify charge-for local use only) .TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing S.i.m As) FACILITY IDM 1 <br /> Aso A) C, L L L C- <br /> LOCATION VNTHIN SITE(Oph'ona <br /> I.TANK DESCRIPTION <br /> TANK IDM TANKMANUFACTURER COMPARTMENTALIZED TANK ❑ Yea No <br /> // z�U ,/� AZA--- <br /> IIHai.mmpleleone mgeloreachcom <br /> TAfUMpamnent. <br /> DATEINSLLED(YEAO) TANKCAPACITYINGALLONS rvUMBER OF COMPARTMENTS <br /> q / 0)6)(90 <br /> ADDITIONAL DESCRIPTION( rbc luxe only) <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> 0 1. MOTOR VEHICLE FUELia. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL <br /> (Il nurkea,comphh Pohohum Type) Dth. PREMIUMUNLEADED ❑ 3. DIESEL ❑ S. AVIATION FUEL <br /> Cl 2. NON-FUEL PETROLEUM 01c. MIDGRADE UNLEADED ❑ 4_ GASOHOL 1399. OTHER <br /> ❑ 3.CHEMICAL PRODUCT CAS K(fmm Hazam.aS Mehaals Inwnlory page) <br /> COMMON NAME prom Hazardous Mafenalx Inwnforypage) <br /> ❑ 4. HAZARDOUS WASTE(InGWea <br /> urea Oil) <br /> r195 UNKNQMN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 01, SINGLE WALL 0 3. SINGLE WALL WITH D 5 SINGLE WALL VATH INTERNAL BLADDER SYSTEM <br /> (CMck one ihm only) 2. DOUBLEWALL EXTERIOR MEMBRANE LINER 095 UNKNOWN <br /> D 4. SINGLE WALL IN A VAULT 099 OTHER <br /> TANK MATERIAL-pnmary hnk 0 1 BARE STEEL A, FIBERGLASS I PLASTIC 0 5. CONCRETE 1395. UNKNOWN <br /> (CMGone Mem.nly) 0 2. STAINLESS STEEL D 4. STEEL CLAD WIFIBERGLASS Cl 8. FRP COMPATIBLE WIIW%METHANOL 1399. OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL-semnaary tank D 1 BARE STEEL 3. FIBERGLASS I PLASTIC 0 8. FRP COMPATIBLE W/lM%METHANOL 1395. UNKNOWN <br /> (Check one Mem only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CIADWIFIBERGUSS 09 FRP NON-CORRODIBLE JACKET 099.OTHER <br /> REINFORCED PLASTIC(FRP) 010. COATED STEEL <br /> ❑ <br /> S. CONCRETE <br /> TANK INTERIOR LINING 13 1. RUBBER LINED 0 3, EPDXY LINING 0 5. GLASS LINING ❑95. UNKNOVM433 DATE INSTALLED <br /> OR COATING 1113 ••,,yy <br /> 2.ALKYD LINING e. PHENOLIC LINING �p e. UNLINED ❑N. OTHER <br /> Check o.ft. <br /> on ) I ` (Forlacel use only) <br /> OTHER CORROSION 0 1 MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 434 DATEINSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ d. IMPRESSED CURRENT >. OTHEft V/TL7�> <br /> (Check.ahm only) ❑ 2. SACRIFICIALANOOE / `` I (Forlocal use only) <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlouluxa a*) OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED <br /> (Cheek atl that apply) D 1. SPILL CONTAINMENT ❑ 1. ALARM ❑ 3, FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALL FLOAT 0 4. EXEMPT <br /> 0 3. STRIKER PLATE <br /> N. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK CMG all that apply). IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only) <br /> 1. VISUAL(EXPOSED PORTION ONLY) 0 S. MANUALTANKGAUGING(MTG) D 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> 0 2. AUTOMATIC TANK GAUGING(ATG) ❑ B. VADOSEZONE D 2 CONTINUOUS INTERSTITIAL MONITORING <br /> D 3. CONTINUOUSATG ❑ T. GROUNDWATER D 3. MANUALMONITORING <br /> ❑ 4. STATISTICALINVENTORY RECONCILIATION(SIR). 0 8. TANKTESTING <br /> BIENNIALTANK TESTING 099, OTHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DA LAST USED <br /> DD EBTIMATEO QUANTITY OF SUBST EREMAINING 435 TANK FILLED W1TH INERT MATERIAL? <br /> '�O gallons 0 Yes No <br /> I <br /> CUPAFORM(4/99) it- O _ Formerly SWRCB Forrn B <br />