BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UN,,AD PROGRAM CONSOLIDATED FORII,,d 1 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 ALb TANK #1 (Mro g per tank) _,, Page-1_of 2 TYPE OF ACTION `}}�f[J I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ry (Chat me mm my) -_ ❑ 7 PERMANENTLY CLOSED ON SITE ((Iygtwt�� ❑ 3 RENEWALPERMIT (Spaiy naaon-fm lopluu my) (SPwFyrman-forlou..y) ❑ 8 TANKREMOVED 430 BUSINESS NAME(Sane M FACILITY NAME"'DBA-Mr.,Berm.Aa) FACILITY ID: I I SAFEWAY FUEL CENTER #1769 O b 1 Z -7 1 6 y LOCATION WITHIN SITE(Opuond) OI I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agen y) TANK ID# -T& Q S 15 S S 7 32 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes No 4M 1769-1 MODERN WELDING R'Ya.complete one page for each compm oa DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY M GALLONS Os NUMBER OF COMPARTMENTS 437 3/1/01 20,,000 ADDITIONAL.DESCRIPTION(For loW uae ony) 438 IL TANK CONTENTS TANK USE 439 . PETROLEUM TYPE 440 I. MOTOR VEHICLE FUEL 09 la. REGULAR UNLEADED 02. LEADED ❑5. JET FUEL afmmi,al mplde Pmolam Type) Cl 1b. PREMIUM UNLEADED 03. DIESEL 06.AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT _COMMON NAME.(liven Hamdoua Matmiala Inventory page) 411 CAS#(f.Hazddoua M.tm Inventory page) 442 04. HAZARDOUS WASTE (I ckrda I/4M 08) ❑95.UNKNOWN TIL TANK CONSTRUCTION TYPE OF TANK 0 I. SINGLE WALL 0 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chekoneitemonly) EXTERIOR MEMBRANE.LINER 095. UNKNOWN 0i DOUBLE WALL ❑4. SIGNLE WALLIN VAULT 099. OTHER_ TANK MATERIAL-poen.rant 6 I. BARE STEEL 0 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN 444 (Chr one item ony) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/l00%METHANOL _ ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-aamdary tank 0 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN a5 (Check meben my) ❑2. STAINLESS STEEL 1A4. STEEL CLAD W/FIBERGLASS ❑& FRP COMPTIBLE W/10095 METHANOL 099.OTHER_ REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING L1 I.RUBBER LINED E3 3.EPDXY LINING5.GLASS LINING 95.UNKNOWN 44s. DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING a�•LI6 UNLINED ❑99 OTHER (Chakme item ony) (Forlod uae my) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN acs DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Chenmeadnony) N/A ❑2 SACRIFICIAL ANODE (Forbpal uu oey) SPILL AND OVERFILL YEARINSTALLED 450 TYPEooa wy) 451 OVERFILL PROTECTION EQUIIPyPy�M�ENTNEAR INSTALLED 452 (Check au tat hwpy) I& I SPILL CONTAINMENT 2001 5 GAL. BUCKET 01 ALARM _ Y63 FILL TUBE SHUT OFF VALVE 2001 {92 DROP TUBE 2001 W/0V2Cfi11 ValVC 0 BALL FLOAT_ ❑4EXEMPT 93 STRIKER PLATE 2001 PLATE IV.TANK LEAK DETECTION(A deacupuon ofthemorrrWng pro shall be wbmimd Io the Loralagan.Y) IF SINGLE WALL TANK(Chat all then appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Chen one itmo ooly) ❑ I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑y�1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE 6 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATC ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4STATISTICAL INVENTORY RECONCILIATION ❑STANK TESTING (SIR) BIENNIAL TANKTESTING 09 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 955 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 436 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No v%w \or