BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK C.a., 1 OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per US im 1-1``�1 l� TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,I1,111,IIN d[K el4 1 4in ❑ I.NEW PGRMIT NEWAL PERMIT 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE X7.U2F PERMANENT CLOSURE ON SITE S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 410a DATE EXISTING U T 1SCOVER 1=P ITAI HEALM 1. FACILITY INFORMATION A h.� FACILITY ID#(Agency Use Only) I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Miles Trust Property BUSINESS SITE ADDRESS103 1940 South American Street CITY SWckton,CA 95206 Io4 II.TANK DESCRIPTION TANK ID 432 TANK MANUFACTURER 4" TANK CONFIGURATION: Ti IIS'TANK IS 434 Unknown El 1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Com lefe one pacefor each cam anmant in the unit. DATE UST SYSTEM INSTALLED J}5 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 Unknown 250-500 ONE Ill.TANK USE AND CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ I CI[EMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WAS'fE(lncludn Used Oill ❑ 5.EMERGENCY GENERATOR FUEL IfiSC125291.5101 ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 43% CONTENTS PETROLEUM: M<Is.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ b.PREMIUM UNLEADED 440 Ui.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (S ecirvp 440a NON-PETROLEUM;❑ 7.USED OIL ❑ '10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(S ecifr): 4406 IV. TANK CONSTRUCTION TYPE OF TANK IN I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL t INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ I.STEEI. ❑S,FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN El 99,OTHER(S.6 ): 445a OVERFILL PREVENTION ❑ L AUDIBLE.@ VISUAL ALARMS ❑ 2.BALL FLOAT ❑ ,.FILL TUBE SHUT-OFF VALVE 453. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREY ENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONST RUCTION 191.SINGLE-WALLED 02.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM T)PE ❑ LPRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION6l CCR 23 1 4'- Nn11311 458 PRIMARY CONTAINMENT ID 1.STEEL ❑ 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 461 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spccl Po): 461. SECU,v Ry CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444e PIPINGMURBINP:CONTAINMENT SUMP TYPE I.SINGLEWALL El 2.DOUBLE WALL 090.NONE 461d Vl.VENT,VAPORRECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION -TENTPRIMARY CONTAINMENT LSTEEL ❑ 4,FIBFRGL.ASS ❑ 10.RIOT D PLASTIC ❑ 90.NONE ❑ 99.OTHER(SpeciN) 4Ne 4640 VENT SECONDAR';CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 1D 90.NONE ❑ 99.OTHER(Specify) 464f VR PRIMARY CONTAINMENT LSTEEL X61 ❑ ❑ 4.FIBERGLASS ❑ I0.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 4641 64.1 VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ I0.RIGID PLASTIC E9 90.NONE ❑ 99.OTHER(Specifi-) 46th 464h 1 VENT PIPJI,JG TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL 90,NONE 464,. RISER PP,IMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC IN 90.NONE ❑ 99.OTHER(Specify) 464j 46 i RISER SECONDARY CONTAINMENT ❑ LSTEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC © 90.NONE ❑ 99.OTHER(Specify) 464k 464k1 FILICOMPONENTS INSTALLED ❑ I.SPILL BUCKET ❑ S.STRIKER PLATUBOTTOM'PROTECTOR ❑ 4.CONTAINMENT SUMP 451ac VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL Cl 2.DOUBLE WALL 3.NO DISPENSERS M 90.NONE 46% CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696c Vlll. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 445. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. AP L NT IG DATE 470. A LI TNAME(print) 411_ APPLICANTTITLE4T- Reba Veltri Trustee UPCF UST-9-1/2 Rev.(12/2007)