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I � - FIED PROGRAM CONSOLIDATED FOR o\ O\ nom' TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 "�4,0t ((WO peyCS per l8nk) Pipe _ of TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check oro Item only) I. PERMANENTLY CLOSED ON SITE ❑ ❑3.RENEWAL PERMIT (Specify reason-for local use only) (Spaay che+ge-lorlocal use only) ❑ 8. TANK REMOVED 430 ILITY ID BUSINESS NAME(Sams as FACILITY NAME or OBA-Do+ny Business As) FAC / I LOCATION wTHIN SITE(OpboiW 431 3z 3 s. G,yR�s�r�NRoA� r , GtQ. 95376 I.TANK DESCRIPTION TANK IO• TANK MANUFACTURER /f u COMPARTMENTALIZED TANK Yes ❑ No J -rq/ se It-Y .conv le One Pays Fol each/eacom nm em DATE INSTALLED(YEA ) TANK CAPACITY IN GALLONS ONS any.J[2 NUMBER OF COMPARTMENTS 9 Co/N�i9r27iet7+g�/ .'6 aoa 6 p Z AODITIOnAI DESCRIPTION fFarlocal use aAW IL TANK CONTENTS j7Pg�' TANK USE 432 PETROLEUM TYPE MOTOR VEHICLE"L•(+1 muked,ron"N Pauolaum Type) ❑1/' REGULAR UNLEADED /Nva�`,Q./ ❑ 3. DIESEL 6 G�� ❑ 5. JET FUEL �1a PREMIUM UNLEADED 6Q�'1�J1(/L � � ❑ 5. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑1c MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3 CHEMICAL PRODUCT ❑ . COMMON NAME(hom Harerdous Maanals lmtntary pays) CAS M fllom Huantous Malsrtats ln+.0MryopeyeJ 4HAZARDOUS WASTE(kWudes Used Od) 95 UNKNQUVIN M.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one dam only) ;K2 DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT C199 OTHER TANK MATERIAL•Phln>vY tank ❑ 1 BARE STEEL 3. FIBERGLASS I PLASTIC ❑ 5.CONCRETE [195 UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑4 STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-sacoIdary,tank ❑ T BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ e. FRP COMPATIBLE W1100%METHANOL ❑9S. UNKNOWN (Cmeck ens dem only) ❑ 2 STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑9. FRP NON.CORROOIBLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1 RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING El 95 UNKNOVA433 DATE INSTALLED OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING N6. UNLINED ❑99.OTHER fe local use ) (Gm+ck one demo ) OTHER CORROSION ❑ 1 MA NUFACTUREO CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT )(99. OTHER &/A_ (For fonruseoNy) (Check ane dem ww ❑ 2. SACRIFICIAL ANOOE SPILL AND OVERFILL YEAR INSTALLED TYPE(Faloca/use"W OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check as that applyl 1 SPILL CONTAINMENT ❑ 1.ALARM - 9 3. FILL TUBE SHUT OFF VALVE 2. DROP TUBE ❑ 2. BALL FLOAT ❑4. EXEMPT 3. STRIKER PLATE IV. TANK LEAK DETECTION IF SINGLE WALL TANK Check a0 Met ): IF DOUBLE WALL TANK OR TANK WITH BLADDER rCheck one item ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE )(2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUSATG ❑ 1. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑ S. TANK TESTING BIENNIAL TANK TESTING [199 OTHER �1 V.TANK CLOSURE INFORMATION i PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRUO/0AY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLEO WITH INERT MATERIAL? yssons ❑Yes ❑No - ----- -•-.- Formerly SWRC8 Form 8 i