BILLING_2006 - 2008 - Laserfiche WebLink

Home Browse Search

r_7 a VIVIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1`�U (two pages per tank) Page of TYPE OF ACTION F-l 1 NEW SITE PERMIT 4 AMENDED PERMIT Z S CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Check one item only) F-l 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason- for local use only) (Specify reason- for local use only) 8 TANK REMOVED 430 BUSINESS NAME (SameasFACILITY NAME orDBA - Doing Business As)3 FACILITY ID: Quick Stuff #7789 1 FA 01 73 LOCATION WITHIN I (Optional) 471 1. TANK DESCRIPTION (A scaled plot plan with the location of the US I system Including buildings and landmarks shall e submitted to the local agency. TANK ID # 432 TANK MANUFALIUHLIR 433 1 COMPARTMENTALIZED TANK Z Yes 0 No 434 213 TA 0 51 S - /y i % Xerxes If "Yes", complete one page for each compartment. DATE INSTAL (YEAR/ NK CAPACITY IN GALLONS 436 NLfMBER OF COMPARTMENTS 437 7/2006 8,000 2 ADDITIONAL DESLHIP I ION (For local use only) 438 11. TANK CONTENTS 440 n 1. MOTOR VEHICLE FUEL 0 Ia. REGULARUNLEADED 2. LEADED S. JETFUEL (If marked complete Petroleum Type) Ej 1b. PREMIUMUNLEADED 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM n 1c. MIDGRADE UNLEADED 4. GASOHOL n 99. OTHER 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CA5# (from Hazardous Materials Inventory page) 442 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95. UNKNOWN Ill. TANK CONSTRUCTION TYPE OF I ANK Li I . MISJULL WALL Ll J. SINGLt: WALL WITR_ L_j 5. SINGLE WALL WITH IN I ERNAL BLADDER sYS I LM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN FRI 2. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL - primary tank L_j I . KARL!) I I:LL Li 3. FIBERGLASS / PLASTIC L 5. CONCRETE L_j 95. UNKNOWN 444 (Check one item only) El 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS 0 8. FRP COMPTIHLE W/100% METHANOL 99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank (Check one item only) ❑ 2. STAINLESS STEEL R 4. STEEL CLAD W/FIBERGLASS K❑ 8. FRP COMPTIBLE W/100% METHANOL 99. OTHER REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING Lj 1, HU13BER LINED Lj 3.EPDXYLINING 5. GLASS LINING Lj 95. UNKNOWN 446 DATE INSTALLED 44/ OR COATING 2 ALKYD LINING 4 PHENOLIC LINING 6 UNLINED 99 OTHER (Check one item only) (For local use only) OTHER CORROSION 1 MANUFACTURED CATHODIC 3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN ALLED n PROTECTION IF APPLICABLE PROTECTION 4IMPRESSED CURRENT 99 OTHER (Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) (local use only) • (Check all that apply) ❑X 1 SPILL CONTAINMENT 2006 1 ALARM 2006 3 FILL TUBE SHUT OFF VALVE K❑ 2 DROP TUBE 2006 2 BALL FLOAT 2006 4 EXEMPT Q 3 STRIKER PLATE 2006 IV. TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK (Checkallthatapply) IF DOUBLE WALL TANK OR I ANK WI I H BLADDER (Check one 4S4 1 VISUAL (EXPOSED PORTION ONLY) 5 MANUAL TANK GAUGING (MTG) item only) 1 VISUAL (SINGLE WALL IN VAULT ONLY) 2 AUTOMATIC TANK GAUGING (ATG) 6 VADOSE ZONE J 2 CONTINUOUS INTERSTITIAL MONITORING 3 CONTINUOUS ATG 7 GROUNDWATER El 3 MANUAL MONITORING F] 4 STATISTICAL INVENTORY RECONCILIATION F] 8TANKTESTING (SIR) BIENNIAL TANK TESTING r-1 99 OTHER IV. TANK CLOSURE INFORMATION / PERMANENT CLO�URE IN PLACL ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? a gallons 1 1 ❑ Yes ❑ No UPCF (12/99 revised) 10 Formerly SWRCB Form B