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12J U3/ 2UU3 id j: 5G 2Oy4bo34d3 <br />r �; <br />WUUNUIED PROGRAM CONSOLIDATED MOW <br />UNDERGROUND STORAGE TAINKS - TANK PAGE I <br />TANKS <br />(two Iraues per talk) <br />rap _or_ <br />TYPE OF ACTION ❑ 1 n SITE NXMIT [i 4 AMENDED PERMIT E 5 CHANGE OF _NFO3V4AT70i•+ ❑ 6 TENSPCRARY SITE CLOSURE, <br />(Chaak ono iwm wmty) ❑ T POWANENTLY CLOSED ON SITE <br />3 REgZWALPERMrr (Svo6rymom- fo,oW wwonlr) (aveclryrraavn-lbclveslusecniyl ❑ b TANKREMOVED anO <br />EU'SINESSNAME (5AmvUPACILIT'YNAJME,ODA -= ingaw,zi 1u) t FACILITYID: <br />I 1 <br />3 <br />LOCATION WITWIN SCFE (off 431 <br />i <br />L TANK DESCRIPTION (A sealed plot pl= vnth tleo location o :io UST system including buildings utd landmarks shall be submitted to the local agency.) <br />TANK ID 0 TANK MANUFACTURER 433 <br />L'0WARTUENTAL1=1 TANK ZrYc3 No ua <br />IF -Yes'. amoeu ane amge rstt each mmmrm ent. <br />DATE INSTAL D (YEA"O) '05 TANK CAPACiFY rM GA:.LONS 436 <br />NUMBER OF COMPARTMENTS as <br />. SF' /D CVU tivvob <br />2 <br />_ <br />ADDITIONAL DESCRnMON (Poe bell use only) a38 <br />IL TANK CONTENTS <br />TANK. USE 439 <br />PETROLEUM TYPE wo <br />1. MOTOR VF,FLICLEFUEL <br />❑ la. RE©ULAX UNLEADaD p 2. LEADED 0 5. JEFFUEL <br />(1l7,orkadoany1:i4Nm1wnTrve) <br />j3oIb, PRE'MIUMUNLEADED 03. DIESEL ❑6. AVLATIONFUEL <br />❑ L <br />0 la MMORADE'UNLEADED ❑ 4. GASOHOL ❑ 99.0iHER <br />O 3. CMMICALMDJGT <br />COMMON NAME (lken Haku4m,ro NQkv:L;v mwypmgc) 441 <br />C4S7 Ifni k �nl+u+M to le c-v�•7 Lal�> v2 <br />❑ 4. HAZARDOUS WASTE <br />(laaUlmumaca) <br />G a Sol' h t <br />❑ 95. UNKNOWN <br />III, TANK CONSYKUCTION <br />TYPE OF TAINT: U 1. UNCLE WALL 3. SUNGLE WALL WITH j 5. SINGL .. WITORTERNAL DDEit $Y;+7S, t 441 <br />(Citiak an0ipm+rJy) EXrMUOR MEMORANE LINER 0 93. UNKNO", I <br />2. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT 0 N. OTHER <br />TANK MATLRRAL - pAm;vy wnk L BALE sI6EL L. 3. MR)MOLASS / PLASTIC S. CONCRBTE+ 95. L441C4OWN 4" <br />(Check m item Doty) ❑ 2. STAINLlWTS STEEL ❑ 4, 37TEL CLAD WiFIBERGLASS ❑ & FRP COWMI11.E Wn 00% METHANOL ❑ 90. OTHER <br />tj REINFORCED PLASTIC (PRP) <br />TANK MATCRIAL-mmnd.m,Luk BARE STEEL 3. 1C E3 5. CONCRY.TE U 95. UNIL OWN 441 <br />(CAa+kont awn; only) ❑ 2. STAINLF,'SS STEEL D 4. STEEL CLAD W1FtDERGLASS ❑ E. FRP' CONIPTIBLE WtIW/ 1,11ErtIANOL ❑ 99.OTH$R <br />R:51NTORC6L PLASTIC (FRP) [110. COATED STEEL <br />❑ 3. CONCItm <br />TANK IA R LmNG L RUBBER LINED LJ 3. EPDXY WNTNG © 5. GLASS LINING PS. t rn KNOwrr alk DATE INSTALLED 447, <br />OR COATIAIO ❑ 2 ALKkD Li1VYG ❑ 4 PEENOLIC.LLNtNO "_•6 UNLItiBD 0 99 OTN.t".R <br />(Cheek time Tem ally) (rcr lv©I are only) <br />CTMER CORROSION © 1 MANUFACTURED CATBDDICl­,_-S3 FIBERCT.ASS REINF0310ED PLASTIC ❑ 95 UNI? N0)AIN 14DATE rNSTALLED 44D <br />PRC1TCTf01: Lr APPLICA3LE PROTECTION ❑ 41MPRESSED CURAMrr ❑ 99 OTHER <br />(Civolp. sc ilei only) ❑ 2 SACRIFICIAL ANODE (ra, taco wlc onL•) <br />SPILL AND OVWILL (,` YEAR INSTALLED 430 TYPE (>wd ase only) 451 I <br />OVSRF(LL PROTECTION EQUIP :YEAR INSTALL M fee 452 <br />(Cheekau ttot gfpiy) 1 SPILL CONTATFiMRn <br />❑ 1 ALARM 3 FILL :'11BE SHUT OFF VALVE <br />2 DROP TUBE <br />❑ 2 BALL FLOAT ❑ 4 EXEMPT <br />3 S TILIKER PLATE <br />IV. TANK LEAK DETECTION (n tiler p ieu nr man we eab �l7am oho I by submitted w he kkal atFncy) I <br />IF SINGLE WALL TANK(amck allemappiy) 403 <br />if DOUBLE WALL TANK OR TANK WITH BLADDER <br />�cftoL vm iecm Daly) <br />❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 Mp.N'UAL TANX GAUGING (..h4TG) <br />0 l VISUAL (9:1101.2 )MALL IN VAULT ONLY) <br />❑ 2 AUTOMATIC TANTO QAVQV13 (ATO) ❑ 6 YADOSE ZONE <br />J3 2 CONTINUOUS [INTERSTITIAL MONITORING <br />0 3 CONTINUOUS ATO ❑ I GROUNDWATER <br />❑ 3 MANUAL MONITORING <br />❑ 4 STATISTICAL INVEIv-rORY RECONC1L7Anw ❑ d TANK TW7 NG <br />(SIR) BIHNNLAL TANK TBSTENG ❑ 99 OTHER <br />IV. TANK CL05URE INFOR'NA717F17N I PPILI'IANEN"I' CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED (YWMOlDAY) a65 <br />ESTIMATED QUANTITY OF SUBSTANCE REMATNING F TANK FILLED WITH INERT MATEICA17 L4 <br />gallons ❑ Yea CU No <br />LTPCF (12x99 )`wised) 10 Formerly SWRCB Form 8 <br />