BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

. RECElVE1D UNDERGROUND STORAGE 'TANKS -TANK PAGE 1 MAY 1 1 2005 SAN,iOp(f 11 ��YtaB�k Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check out item my) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (SPeeifymasm) (Spwry teamn) ❑ 8.TANK REMOVED BUSINESS NAME(S. .a4 FACRITY NAPS or DBA-Doing Baswe.s A.) 3. FACIi.ITY ID: 1' LOCATION WITHIN SITE(oPfiovel)' 431. I.TANK DESCRIPTION' (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted m the local agency.) , TANK ID# 432. TANK MANUFACTURER 4JJ. COMPARTMENTALIZED TANK ❑Yes No 434. 'S� ��i1 �� G I(Wes,"wmP�e orc Poge fm each conipammmt DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 43]. ('YEAR/M0 rj'DD ADDITIONAL w a. DESCRIPTION(For io .Bray) O 43s IL TANK CONTENTS TANK USE 439. PETROLEUM TYPE 140. X 1. MOTOR VEHICLE FUEL ❑la REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (fl` ecked,mm Il Pewlemn Type) Ib. PREMIUM UNLEADED ❑3. DIESEL [16. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑1 o. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER- ❑ 3. CHEMICAL PRODUCT COMMON NAME(Tmm F1amNou.Materials Invmmry page) 141' CAS#((tom Hezerdou4 Metenels mvwory page) aa2' ❑ 4. HAZARDOUS WASTE (Ind.d Uu OR) ❑ 95.UNKNOWN III.TANK CONSTRUCTION.;,„ TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM a4a (Check one item only) MEMBRANE LINER [195.UNKNOWN 2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tw ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE 95.UNKNOWN 444. (Chxk onenem only) [12. STAINLESS STEEL 44. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER-' REINFORCED PLASTIC(FRP W/I00%METHANOL TANK MATERIAL_sec on4larytwk 1. BARE STEEL 03. FIBERGLASS/PLASTIC 8. FRPCOMP11OLE W/l00%METHANOL 95.UNKNOWN 445. (Check one item only) [12. STAINLESS STEEL3j14. STEEL PFIBEGFAS' [19. RPNON- ODABLE JACKET 99.OTHER REINFORCED (FRP) STEEL ❑5. CONCRETE TANK INTERIOR LINING PO 1.RUBBER LINED 3.EXY LINING 5.GLASS LINING El95.UNKNOWN 446. DATE INSTALLED 4n]. OR COATING ❑2.ALKYD LINING 4.PHENOLIC LINING [16.UNLINED ❑99.OTHER Check ane item only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNO WN Ong. DATE INSTALLED 449. PROTECTION PROTECTION 4.1MPRESSED CURRENT 99.OTHER (HApplicable) [12.SACRIFICIAL ANODE SPILL AND OVERFILL INST STALLED 450. TYPE 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) 1.SPILL CONTAINMENT Z t [I 2.ALAABALL FLOAT_ El 4.EXEMPT E SHUT OFF VALVE 2.DROP TUBE ew& 3.STRIKER PLATE IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER q54. (Check all that apply) (Check one item only) ❑1.VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ��a❑,, 11.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 [18.TANK TESTING (SIR)+BIENNIAL TANK TESTING 099.OTHER V TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456' TANK FILLED WITH INERT MATERIAL? 457. gallons ❑Yes ❑ No 61