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12iO3/2003 d5: b2 <br />20y41b634zi,� <br />PROGrR&M <br />UNDERGROUND STORAGE TAINKS - TANK PAGE 1 <br />TANKS <br />(two pages per --k) <br />raga _ 4r <br />TYPE OP ACTION ❑ 1 NEW SITE PEJLArT p 4 AMENDED PSR ,Cr G 5 CITANG£ OF 1NFOX%1AT7Oh ❑ 6 M91CRARY SITE CLOSURE <br />(weak ow ilcm'mty) ❑ 7 PYRMANENITLY CLOSED O ' SITE <br />263'RENt7:VVAL PERfAIT (SpnoiCY n9snn - for iVal ueo volyJ (spsk'i' rrmm -la local lw only) b TANK REMOVED 430 <br />BUSINESS NAME (31mcu.FACILiTNAMEmDBA-De' Mus ewAu} fACiI`fYIT): <br />I <br />3 <br />hL- <br />� <br />LOCATION WlTHW S[TE ( 431 <br />i <br />L IXNK DESCRIPTION (A scaled plot plan vnth the 10436on a the UST system including buildings and landmruko shall bo submitted to the local agency.; <br />TANK ID # 432 TA?(fi MA�LiFACTURER 433 <br />COMPARTMENTALIZED TANK Yea Na 4111 ! <br />7/I,Lf I l v <br />]f"Yes". aaa�Iele one )wye far clubcomaarmrm. <br />DATE LNSTALLE(YEAWMO) -5 TANK CAPACITY Illi GALLONS 436 <br />NUMBER OF COMPARnMENTS oil <br />e S- �> vbv A/D UUv <br />Z <br />ADDITIONAL DESCREMON (rd, ball use only) 13S <br />IL TANK CONTRNTS <br />TANK USE 479 <br />PETROLEUM TYPE 440 <br />01. MOTOR VIRQCLEFUEL <br />Q )a, REGULAR UNLEADED Q 2, LEADED Q 5. JET FUEL <br />01muked=w*1onv*1v nTyyve) <br />Q 1b. PREMIUM WLEADzD -a3, DIESEL ❑ 6, AVIATION FUEL <br />❑ L NON.FUEL FETROLEL29 <br />❑ 1;. MIDGRaDS UNLEADED ❑ 4. GASOHOL In 99, OTHER <br />❑3, CIMMTCALPROGUCr <br />COM.b1GNNAME (ft -H" -4-w Adwiukjmmusypc3U <br />CAR* (CremR,w>alwwmotc imim,=.ypepe) 442 ' <br />Q 4, HAG.4ADOUs wAs; ¢ <br />oadvilmuaaaoa) <br />❑ 95. UNXNOWN <br />III. TANK CONnItUCTION <br />TYPE OF TANK U 1. SrNOLZ WALL C 3. SMEZE WALL WITH Z1 S. SINGOLSWALL WIVEM12NAL BLADDER SYSTEM 44] <br />(CnwAakiumerJy) EXTMUORMEMORANELMR 093. UNIOgOWN <br />,/,�,.,`` <br />-1. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT Q 99. OTHER <br />TANKMAT MWAL-p,im:ny4 I. BARE STEEL E3 3. FISF,&OLASS/PLASTIC J. CONCRBT>? U 95. GNJLNUWN 4" <br />(Check = Us Orly) 13 2. STAINLESS STAEL D a, S7 -,EL CLAD W/FIBERGLASS ❑ X FRP COWMPLS W/l 00.4 METHANOL ❑ 09 OTHER <br />REINFORCED PLASTIC (PRP) <br />TANIMATERIFL -wand-=ink :. BA E33TEEL 3. 1C ff-5-CONCRE713 Lj 95. UNKNOWN 44= <br />(cheek on; a9 ❑ 2. STATNLEW 57EEL © 4, STEEL CLAD WJPMEPCIT-ASS 08, PRP CCmYr1BLE W!?m mak ANOL ❑ 99.OT"R <br />REINFORCED Pi„ ),STIC (FRP) ❑ 10. COATED STEEL <br />❑ 5. CONCRCTE <br />TANK IN R LINING 01.RLIBBERLMD LJ 3. EPDXY LrNiNG 0 S. GLASS LINING 95. UNKNOWN 44 DATE INSTALLED ea7 <br />OR COATING ❑ 2 ALKYD LD'nNO ❑ 4 PHENOLIC LINING -Q.4 UNLINED ❑ 99 OTHER <br />(Clink one km ally) (rar 1=1 tie only) <br />CTMER CORROSION [I1 MANUFACTURED CATI30DIC 31�3 FIBERGLASS REINFORCED PLASTIC ❑ 93 U,,KNOWN DATE RNSTALI.1 4;y <br />PkCTEC TONff APPLICA3Lx PROTUCTION Q 4IMPkESSED CURRENT ❑ 99 OTHER <br />(Clxekanei=only) ❑ 2 SACRIFICIAL A NODS (For Toeat onFT <br />9FILL ANA OVERFbL YEAR INSTALLED 45U TYPE (Ioent esr Orly) e51 <br />UVAKFILL PR077-C DN EQU2,%jF.V,YEAR INSTALLED 4+'2 <br />(06-ilkoll Ihot:>Ilpiy) ( SPILL CONTAINMENT <br />❑ 1 ALAILLI FILL TUBS SHUT OFF VALVE <br />� <br />`.62 DROP TUSIS <br />❑ 2 BALL FLOAT ❑ 4 EXEMPT <br />3-1 PUKER PLATE <br />TV. TANK LEAK DETECTION (AdeaedtAimarOlt mercwd Wproymm Thai be tubmimlIto thelocal ap licy.) <br />IF SINGLE WALL TANK. (ctmk muelatapply) 4n <br />IF DOUBLE WALL TANK OR TANK WITH BT,ADDER <br />Owk um item w1y) <br />❑ 1 VISUAL (EXPOSED PORTION ONLY) [35 MAA'11AL rmx GAUGTNG (!CG) <br />[I 1 VISUAL (SINGLE WALL 1N VAULT ONLY) <br />❑ 3 AUTOMATIC TANK GA1;,0VQ (ATG) ❑ 6 VAD05P ZONE <br />❑ 2 CONTCIUOUS INTE&STITIAL MONITOIUNG <br />Q 3 CONTINUOUS ATG) ❑ 7 GROUNDWATER <br />❑ 3 MANUAL MONITORING <br />❑ 4 STATISTICAL PWENTORY RECONCILIATION [i 3 TAXK T33777101 <br />(SIR) BIENNL4L TANK T53TING ❑ 99 OTFER <br />IV, TANK CLOSURE INFOR.'NATION ( PEWMANES1 CLOSURE IN PLACE <br />ESTIMATED DATE LAST USED ('YRJMO/DAY) 5 <br />ESTIMATED QUANnW OF SUBSTANc6 REMATNTNG ` TANK FILLED WITH INERT MATERIAL! <br />p1lous ❑ Yes 0 No <br />U?CaF 0099 mvisad) <br />10 <br />Formerly SWRCB Form B <br />1\w <br />