BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

QED PROGRAM CONSOLIDATED FORM �� V W1 /TANK: TA0133003 PR#: PRO231330 a\ \�S UNDERGROUND STORAGE TANKS -TANK PA ) FAC#: FA0003964 LI! 3 03 (two pages per tank) TYPE OF ACTION ❑ INEW SITE PERMIT ❑4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATIONPage 2 of5 ❑6 TEMPORARY SITE CLOSURE "7 ❑ T PERMANENTLY CLOSED ON SITE ❑ 3RENEWAL PERMIT lsavmf rAoml me oN.l (P ry emm.ro I t Re Dory) _ ❑STANK REMOVED 439 BUSINESS NAME IS-FACiLIT NAMForDBA-Doing Bu nss As) FACILITY ID: PR N: 1 LODI PUBLIC SAFETY BUILDING 3 FA0003964 1 PR0231330 LOCATION WTHEN SITE(DPdnmO 230 W ELM ST,LODI 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be subnritted to the local agency.) TANK ID# Tank#: 3 412 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0133003 PERKINS WELDING SACRAMEN R•Ym,mirylaenropager oa magarmual. DATE INSTALLED(YEAR/MO) 455 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 12,000 ADDITIONAL DESCRIPTION(Fmtaml u:eoay) 438 D-TANK CONTENTS TANK USE 439 P ROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL la.REGULAR UNLEADED ��❑yy 2.LEADED F] 5.JET FUEL Ofnuhd magbePmWessn TSpe) E] lb.PREMIUM UNLEADED (p 3.DIESEL ❑ 6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER ❑3.CHEMICAL PRODUCT COMMON NAME room Ro,onsm Marmot,,lm�mm CAS# fimn Ruardouaatmaials lmm page) ❑ 4.HAZARDOUS WASTE ( gpage) pl ( roo'P 8 ) 44z (ImM1da Usd OiO ❑95.UNKNOWN 111.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Croak arc flan mly) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ®2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC [:15.CONCRETE ❑ 95.UNKNOWN 441 (Chkme ium Dory) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-smondar,tank 1.BARE STEEL ❑ IBERGLASS/PLASTIC ❑ 5.CONCRETE El 95.UNKNOWN 445 (Cheek arc Ilan my) E]2.STAMLFSS STEEL 4.STEEL CLAD W/FIBERGLASS ❑ S.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER a ❑ 5.CONCRETE TANK INTERIOR LINING ❑ L RUBBER LINED E]3.EPDXY LINING E] 5.GLASS LINING E]95.UNKNOWN 446 DATE INSTALLED 097 OR COATING (Cha nan my) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (Falai we miry) OTHERCORROSION I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN Ns DATE INSTALLED M9 PROTECTION IF APPLICABLE PROTECTION (CTehankanmy) ❑4 IMPRESSED CURRENT E] 99 OTHER E] 2SACRIFICW.ANODE (For bol uemuy) SPILL AND OVERFILL/ YEAR MSTALLE450 TYPE(laul me any) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all mar appy) •L-`eJ�J SPILL CONTAINMENT El YEAR V3 FILL TUBE SHUT OFF VAL` 2 DROPTUBE ❑ 2BALL ❑ 4EXEMPT ❑ 3 STRIKER PLATE FLOAT IV.TANK LEAK DETECTION(A dmdpum ofm 000nhmbgpoo sbauh smmindto Bu loeal rimer) IF SINGLE WALL TANK(Chak an nut appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Ch .ftcnmy) 2 AUTOMATIC TANK GAUGING ATG ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ (AID) ❑ 6VADOSEZANE ❑3 CONTINUOUS ATG ❑ T GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ STANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑"OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTIIV OF SUBSTANCE REMAINING 436 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)