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AFIED PROGRAM CONSOLIDATED FORM TANKS �- I I S I )--? \�2",o-• UNDERGROUND STORAGE TANKS - TANK PAGE I (Two pages per tank) Page 1 of 2(new tank) TYPE OF ACTION 1.NEW PERMIT ❑ 4 AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION 0 6.TEMPORARY TANK CLOSURE 430. (Check one item only) 0 3.RENEWAL PERMIT New 8,000 Gal.Diesel Tank [3 7.PERMANENTLY CLOSED ON SITE (specify reason) (specify-) 0 8.TANK REMOVED BUSINESS NAME(same as FACILITY NAME or DBA-Doing Business As) 3. ID:1 FACILITY Pacific Bell FA 06 1 T LOCATION WITHIN SITE(optionao 431. .... ......... ................... ...... ................ ......-.............. ............ ......................... .................... ...... .. ............ ........... ................ ....... .......................... ................... ....... ....... .................. . ........... .... ....... .................... ..............:.::::::::::::::::::::.: .....:::::::::::>::::. .... ..... ...... ....................... .. ..... .. ..... ............ .. . ... .. .................. ................................... ............ .. .. .. ..... - P ; ::>:'>:::::.....*........... ......... ... .......... .. ww., ............. ............. -,V -.4 --hi b .-CA, 0 ...89-..........P:W a we p .....i W TANK ID# 432- TANK MANUFACTURER 433. COMPARTMENTALIZED TANK []Yes Z No 434. ti-03 3 Modem Welding If"Yes,"complete one page for each compartment DATE INSTALLED 435- TANK CAPACITY IN GALLONS 436- NUMBER OF COMPARTMENTS 437. (YEAR/MO) New(probably 2001) 8,000 1 ADDITIONAL DESCRIPTION(For iocduw only) 438. ........... ............ ........... .. ........ .. -..................................... . ................ ..... ....... .... . ......................................... ........... ........................ ........ .. ...........::....;%.................. ............................. ........ ................ ...................................................................... ...... ......................... ......... ... .......... ........... ............ T.A . ............ ................................... ............................... ................................ ......... ..................... ............... :X::N TANK USE 439- PETROLEUM TYPE 440. 0 1. MOTOR VEHICLE FUEL 0 Ia. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL Of checked,complete petroleum Type) [3 lb. PREMIUMUNLEADED 0 3. DIESEL [3 6 AVIATION GAS ❑ 2. NON-FUEL PETROLEUM 0 1c. IEDGRAD]EUNLEADED 0 4. GASOHOL [199.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory pap) 441. CAS#(from Hazardous Materials inventory page) 442. ❑ 4. HAZARDOUS WASTE (Includes Used Oil) C 95.UNKNOWN ..............I........... ...... ........................... ...........................- ...... ................... . .......... ............. . ............... .............. ............ ........ TAK-C ......... ... .... .... ........... .. ........... ... .... ............. .... ... .................. ........................ ........................... ....................... ............................................................... ................ TYPE OF TANK [11. SINGLE WALL 0 3. SINGLE WALL WITH EXTERIOR 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER [195. UNKNOWN 0 2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT 0 99. OTHER TANK MATERIAL-pnmarytank 0 1. BARE STEEL El 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL 04. STEEL CLAD WIFIBERGLASS 0 8. FRP COMPATIBLE 0 99.OTHER: REINFORCED PLASTIC(FRP) W1I00%1vlETHANOL TANK MATERIAL-secondary tank [11. BARE STEEL 3. FIBERGLASS/PLASTIC 8. FRP COWTIBLE W/I 00%METHANOL 0 95.UNKNOWN 445. (Check one item only) 0 2. STAINLESS STEEL 4. STEEL CLAD WIFEBERGLASS 0 9. FRP NON-CORRODABLE JACKET 0 99.OTHER REINFORCED PLASTIC(FRP) 0 10. COATED STEEL 13 5. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED 3.EPDXY LINING 0 5.GLASS LINING 0 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING C1 2.ALKYD LINING ❑4.PHENOLIC LINING 0 6.UNLINED ❑99.OTHER 1988 (Check one item only) OTHER CORROSION L3 1.MANUFACTURED CATHODIC 0 3.FIBERGLASS REINFORCED PLASTIC 95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION [3 4.R,1PRESSED CURRENT ❑99.OTHER 1988 (If Applicable) Q 2.SACRIFICIAL ANODE I SPILL AND OVERFILL ' YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) 19 1.SPILL CONTAINMENT _2001(unconfirmed) N 1.ALARM (2001) 0 3.FILL TUBE SHUT OFF VALVE (2001) 0 2.DROP TUBE 2001(unconfirmed) 0 2.BALL FLOAT(2001) 0 4.EXEMPT 0 3.STRIKER PLATE 2001(unconfirmed) ......... ....... ................... ...... ...........-.... ............ .............**........... ............ . ............ ........ .......... ............ ......... .................. ........... ......... ............... .... ....... �. -- NX-11, TM ............................ ................ �w...:... ............ ........... TA ........... .................. ... .......................... ................................... .............. ..................... ....... ..................................... .................................... ...........- ......... .................... .... . .... .......... ............ . ... ................ --- .......................... ...........a' ............................................ ......... .......... ...... . . ......... ........... . .....................:"........ IF SINGLE WALL TANK 453- IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Checkall that apply) (Check one item only) [3 1. VISUAL(EXPOSED PORTION ONLY) 0 5.MANUAL TANK GAUGING(mm) ❑I.VISUAL(SINGLE WALL IN VAULT ONLY) 0 2. AUTOMATIC TANK GAUGING(ATG) Ej 6.VADOSE ZONE 2.CONTINUOUS INTERSTITIAL MONITORING El 3. CONTINUOUS ATG 0 7.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION [3 8.TANK TESTING (SIR)+BIENNIAL TANK TESTING 13 99. OTHER ........ ...... ... . ...... .......................................... ...... ....... ..... .... .. ... ................. os ..............I.... ..... . ..... ..... ........... .. ............ .... .... . . . ...................... .. ..................... ...... .................w............ ......................... ..... - ...... ........... ....... -.. ..... ...........-... ..........va...................................................... ........ ..................................... ........ ... ................... ...- 1 -.......... ESTIMATED DATE LAST USED(YR/MO/DAY) 455- ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457. Currently active gallons 0 Yes El No UPCF hwfwrc-b(1/99)-1/4 http://www.unidocs.org Rev.02/16/00