BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM` a TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 /two pages Perfank; Page _ of _ ❑ 5. CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE TYPE OF ACTION ❑1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ T. PERMANENTLY GLOSSED ON SITE (Chart one nem oNy) ❑3. RENEWAL (SPecN mason-lor 1-u ose-11) (,,,,yNnrge-IarlaW use oMy) ❑ B. TANK REMOVED 4J0 PERMIT Y ] FAGIRY ID 0'3i BUSINESS NAME (Same u FACILITY NAME or DBA- Doing emineu Aa) "i ow .], LOCATION WITHIN SUE (Opaonal) I. TANK DESCRIPTION TANK 100432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yea o 431 Idt' 11-Yea:- pww ens on. for each co mUH.I* P�v e�n �JC /jl 4Jfi NUMB ROFC MPMTMENTS DATE IN TALLIED (Y ) AS PNK CAP�A�JITY IN GALL NS _ _ 000 IL TANK CONTENTS TANK MATERIA. -secondary Unk❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑9.10 FRP BLE JACKET ❑ N. OTHER (Check one it.. oMy) 02. STAINLESS STEEL ao TANK USE 439 PETROLEUM TYPE ❑ 2. LEADED ❑ S. JET FUEL Z-1. MOTOR VEHICLE FUEL ❑,a. REGULAR UNLEADED ❑ ❑ 8. AVIATION FUEL (If marked, compkin Pew. nType) �.b 3. DIESEL PREMIUMUNLEADED❑g9, LT. OTHER ❑ 2. NON -FUEL PETROLEUM ❑ 3. CHEMICALPROCUCT ❑ tc MIOGRAOE UNLEADED ❑ 4. GASOHOL MIDG 441 CAS%(from Haxardaus MarodaU lnwnhay FaINO u2 ❑ 4. HAZARDOUS WASTE (Ink des COMMON NAME (from HaxLdow Mafemis Imenfory Pa9a) Used O1) 1 11 Ir, / 8006 �lP( ❑ 95. UNKNOWN L ,1 So Gl f_ ❑ 2. DROP TUBE III. TANK CONSTRUCTION �. •. ry' '% _.• -:r .r; :,', ❑ S. SINGLE WALL W,TH INTERNAL BLADDER SYSTEM 443 TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN (Check one item oNy) ' �T om2 . DOUBLE WALL ❑ 4. SINGLE WALLIN A VAULT ❑99. OTHER TANK MATERIAL-ptlmary UNf ❑ 1 BARE STEEL ❑ ]. FIBER fiLA55/PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 099. OTHER TANKTESING STEELCLAD ❑ S. FRP COMPATIBLE WN00% METHANOL (Checxone item oNy) ❑ 2. STAINLESS STEEL X4. 458 TANK FILLED WITH INERT W TERIAL4 457 XCIXrVnVcurw••v •. HS ❑ S. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN TANK MATERIA. -secondary Unk❑ 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑9.10 FRP BLE JACKET ❑ N. OTHER (Check one it.. oMy) 02. STAINLESS STEEL '�4. STEELCLADWLASERGLA55 ORTED TEFL REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ S. CONCRETE DATEINSTALLED HT TANK INTERIOR UNING ❑ )_ RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING 095. UNKNOWN N8 ❑99. OTHER CROOKING ❑ 2 AU(YD LINING ❑ 4. PHENOLIC UNING ❑ S. UNUNED FWIOW use oN 449 Cheri one Rem en DATE INSTALLED ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑ N. UNKNOWN 449 OTHER CORROSION ❑ 1, MANUFACTURED CATHODIC PROTECTION IF APPLICABLE PROTECTION ❑ O. IMPRESSED CURRENT 099. OTHER (Forkalueonly) (Check rote Rve,o ly) ❑ 2. SACRIFIGIALANODE 450 TYPE (Far lool use oMy) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 SPILLANDOVERFILL YEAR INSTALLED lollfyj ❑ 3. FILL TUBE SHUT OVALV�/Y /1 07 �...1. ALARlollf� (Checkaafw.ppy) SPILLCONTANMENT ❑ 2. BALL FLOAT ___ ❑ 4. EXEMPT ❑ 2. DROP TUBE ❑ ] STRIKER PLA10•-.. �. •. ry' '% _.• -:r .r; :,', ,,N9_TANK LEAK DETECTION. =k t'• ^µ -. DOUBLE WALL TANK OR TANK WUH BLADDER (ChKt omee eNy). 454 IF SINGLE WALL TANK (Check aS Maf appy): 453 IF ❑ 1. (SINGLE WALL IN VAULT ONLY) ❑ 1. VISUAL (EXPOSED PORION ONLY) ❑ S. MANUAL TANK GAUGING (MTG) CONTINUOUS INTERSTITIAL MONUORING CONTIN ❑ 2. AUTOMATIC TANK GAUGING( ATG) ❑ a. VAOOSEZONE ❑ ]. MANUAL MONITORING ❑ T. ❑ ]. CONTINUOUS ATG GROUNDWATER ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)S. TANKTESING SIENNIPLTANKTESTING N. OTHER _ I PERMANENT CLOSURE IN PLACE V.TANKCLOSUREINFORMATION 458 TANK FILLED WITH INERT W TERIAL4 457 ESTIMATED DATE LAST USED (Y(LMNDAY) 455 ESTIMATED QUMITLTY OF SUBSTANCE REMAINING Is" ❑ Yu ❑ No Fofineriy SWRCB Form B UPCF (1/99) • •