BILLING_2011-2018 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORIo. ONN(Doe S Z3 form pt I tt UNDERGROUNDSTORAGETANK ATI OPERATING PERMIT APPLICATION-TANK INFORM U TYPE OF ACTION (Check mre item only. For anus T pemlanent closure m removal,complete only this section and Sections 1,11,III,IV,and DC bt-+W) 43n ❑ 1.NEW PERMIT'. ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE O!'INFORMATION 6, TEMPORARY VST CLOSURE 7.USTPERMANENT CLOSUREONSITE 8.UST REMO"AL DATE UST PERM NTLY CLOSED: 430e DATE EXISTING UST DISCOVERED: von ii I. FACILITY INFORMATION FACILITY ID N(Agency Use Only) _ - ^j' � BUSINE A Smne as FAC LITY N E or DBA-Doing Business As) 3 BUSINESS RE AD IU3 CITY d r Ica H.TANK DESCRIPTION 7-0 TANK IDN 432 TANK MANUFACTURER 013 TANK CONFIGURATION: THIS TA 4K IS 430 _ 1.A STANtrALONE TANK �� 5� ) ya..� I .ONE IN A COMPARTMENTS[ UNIT. `'JJ/J( N YWV Com lnearo PoreecA mnl Iaeuml. DATE UST SYSTEM STALLED 415 TANK CAPACITY IN GALLONS a36 NUMBER OF COMPARTMEN rS IN THE UNIT 4n III.TANK USE AND CONTENTS TANK USE la. OTOR VEHICLEFUELIN0 ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 HEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Imludo UndGlO ❑ 5.EMEROENC Y GENERATOR FUEL i I C 12Re1.50)) 439e ❑ 6. THER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Si ecity): - CONTENTS PETR LEUM: ❑ Ia.REGULAR UNLEADED ❑ Ic1EIDURADE UNLEADED ❑6. bAPREMIw t aLEADED 4ao ❑ 3.DIESEL ❑ 440. ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OT2ER PETROLEUM (Specify): 3 NON-l� OLEUM:❑ 7.USED OIL El10.ETHANOL 11.OTHER NON-PETROLEUM S eci : - aaab IV. TANK,CONSTRUCTION 1.SINGLE WALL 2.DOUBLE WALL 95.UNKNOWN 445 TYPE OF TANK 4a4 PRIMARY CONTAINM INT Ll I.STEEL 3.PR3ERGLASS U 6.INTEKNALBLAODER as 7.STEEL+INTERNAL LINING 095.UNKNOWN 99.OTHER S ciry): - 445 SECONDARY CONTA MENT PU1.STEEL JM3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER 0 7.JACKETED 443. ❑ 911.NONE 95.I1NKNOWN 9%OTHER ): 452. OVERFR.L PREVENT( I.AUDIBLEB VISUAL ALARMS 2.BALL FLOAT 3.FILLTUBE SHUT-DPF VALVE ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL REVENTION EQUIPMENT V. PRODUCT)WASTE PIPING CONSTRUCTION 460 PIPING CONSTRUCTIO I.SINGLE-WALLED .DOUBLE-WALLED 99.OTHER SYSTEM 1.PRESSURE 2.GRAVITY ).CONVENTIONAL SUCTION 4.SAFE SUCTION[2l CCR 126M 311 4N PRIMARY CONTAINM NT 1.S MEL 4.FIBERGLASS I.FLEXIBLE 10.RIG D PLASTIC 46a ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTNER(S ify): 4616 SECONDARY CONTAI MEM 1,STEEL .FIBERGLASSU s.FLEXIBLE 10.RIG.D PLASTIC 464c ❑ 90.NONE [195.UNKNOWN ❑ 99.OTHER(specify): - 464d PIPINGR'(1RBINE CON INMENT SUMP TYPE I.SINGLE WALL 2.DOUBLE WALL U90.NOT E VENT,VAPOR RECOVERY(VR)ANDRISER/FII L QIPE PIPING CON STRUCTION ° VENT PRIMARY CONT INMENT L STEEL 4.FIBERGLASS 10.RIGID PLASTIC464 90.NONE 39.OTFPER(SpxiQ') 464e1 464f VENT SECONDARY C AINMENT I.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 39.OTHHR(Specify) 4640 4646 VR PRIMARY CONT ENT I.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 19.OTHER(Specify) 4 I 464, VR SECONDARY C INMBNT L STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(SPmPY) 464h1 2.DOUBf.E WALL 90.NONE 4 61, VENT PIPING TRANS ON SUMP TYPE 1.SINGLE WALL 46G RISER pR@iARY CO INMENT J.STEEL 4,F®BRGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Spacity) 46a,1 46ak RISER SECONDARY C NTAMMENT 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Spmity) �4k1 1 451e< FILL COMPONENTS I TALLED I.SPILL BUCKET 3.STRIKER PLATE/BOTTOM PROTECTOR 4.CONTA NMENT SUMP - VII.UNDER DISPENSER CONTAINMENT lUDC) a�4 CONSTRUCTION TYPE .SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 4sv� CONSTRUCTION MAT RIAL 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 99.OTHER( cd)') - VIII. CORROSIO ECTION As STEEL COMPONENT P OTE.CTION ❑ 2.SACRIFICIAL ANODE(S) [14.IMPRESSED CURRENT ❑6.GOLATION UL APPLICANTSIGNATURE CEKTMWICATION: eerlB'y that this UST gUen ca Is mpatlbk�Wbused"elWmaaee stood sad that the 1sdo5s atllw W'^`'b°d Yndl4tllaa.aaaratR 1, fa..c Bance vNt ---------4W_ - APFLICANTSIGNA URE DATE a�"�J /� � 4n. - °11' APPLICANT TITLE 6� �'� Aol APPLICANT NAME 't] r -.6 a r,(122007) UPCF UST-B-1/2 '.„' 5 _a