BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

a *IED PROGRAM CONSOLIDATED F010 UNDERGROUND STORAGE TANKS - TANK pAGE 1 Es� AL TAIVI�s /A 06�5 211 o (two pages per tank) TYPE OF ACTION ®1 NEW SITE PERMIT 4 AMENDED PERMIT P&""`I° 4 ❑ ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE I '1 (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE 1 ❑ 3 RENEWAL PERMIT (Specifyrrnson-forlocal_emly) (SPecifyte_on-forlocal_eonly) ❑ 8 TANK REMOVE BUSINESSNAME(same_FAca1TYNAMEor DBA-Doing Bosineea As) o Chevron Station#210997 3 FACILITY ID: 0 0 0 0 0 0 0 0 0 0 0 1 LOCATION WITHIN SITE(Optiand) L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) 431 rU ID# 43z TANK MANUFACTURER 433 COMPARTMENTALIZED TANK E]Yes ® No 434 �L"'RXE`S If-Yes'. --Plate one Page for each compamnrnt. INSTALLED(YEAR/MO) a3s TANK CAPACITY IN GALLONS a36 NUMBER OF COMPARTMENTS t Install 20,000 4J7 0 ONAL DESCRIPTION(For local use only) 99&Colony Drive,Ripon CA 95366 438 IL TANK CONTENTS ANK USE 439 PETROLEUM TYPE OTOR VEHICLE FUEL ®la. REGULAR UNLEADED 44.❑2. LEADED ❑5. JET FUEL complete Peo-olrnm Type) ❑16 PREMIUM UNLEADED 3. DIESEL❑ ❑6. AVIATION FUEL ON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHEREMICAL PRODUCT COMMON NAME (fmm Hazerdars Materals le,,on ry page) 441 CAS#(from Haanrde_Mazcnals Invento 442 ZARDOUS WASTE ry pass)d«Used Oil) REGULAR UNLEADED 800-61-9 ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 02. DOUBLE WALL [34. SINGLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL-primary rank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC Ll 5. CONCRETE ❑95. UNKNOWN 444 (Check ane item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS E18 FRP COMPATIBLE W/100%METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank ❑1. BARE STEEL ®3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑B. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99 OTHER (Chack one item only) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 448 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE SPILL AND OVE (For local use only) RFILL YEARINSTALLED 45u TYPE(lacal_.only) 451 OVERFILL PROTECTION EQUIPMEN 1:YEAR INSTALLED 452 (Check all rhaz apply) ® I SPILL CONTAINMENT ®1 ALARM Remote 2002 Overfill AudibleNisual Alarm ❑3 FILL TUBE SHUT OFF VALVE 2 DROP TUBE ®2 BALL FLOAT OPW53VML-3180 ❑4EXEMPT ®3 STRIKER PLATE Tarek IV.TANK LEAK DETECTION(A description ofthe monitoring program shall be submined he the local agency.) IF SINGLE WALL TANK(cne.k all amt apply) 453I1DOUBLE WALL TANK OR TANKWITHBLADDER 454 ❑ 1 VISUAL(EXPOSED PORTION ONLY) (Check one item only) ❑5 MANUAL TANK GAUGING(MTG) ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER_ 1V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 056 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) 173 Fonnerly SWRCB Form B