BILLING 2004-2007 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM + TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) N , I of L TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT jK 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one iun only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (specifymason-forlocalaceonly) (Sptcify mown-forloca oae only) ❑ S TANK REMOVED 430 BUSINESS NAME(Samcaa FACE.ITYNAMEor DRA-Doing Ensineesm) FACILfTY[D: l D ' LOCATION WITHIN SIT (Opeow) 431 I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted in the local agency.) TANK ID# 632 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes R-1� 434 A10,Z - US IZ OLue-Ls (ev-. ,nz4 If"Yee",complene one page for each compamnent. DATEIN TALLED(YEAR/MO) 635 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3/ 9z- ADDITIONAL ZADDITIONAL DESCRIPTION(For local ast only) 438 If.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 410 AL MOTOR VEHICLE FUEL ❑Ia. REGULAR UNLEADED ❑2. LEADED 05. JET FUEL (Ifmukcd wmplde Petroleum Type) ❑lb. PREMIUM UNLEADED JK3. DIESEL 06. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (eom Havraoua Materials Wvwtory page) 441 CAS#(from Hawrdous Materials Inventory pest) 142 ❑4. HAZARDOUS WASTE ,,11 �+ (Iwwmueedou) �1LSGC I'iJ P� OAC AL66FL1717 -•3L[-/- ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WZL----M 3. SINGLE WALL WITH Lj 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chock oee item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN A 2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank 1. BARE STEEL 'IFIBERGLASS 5. CONCRETE Lj 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPTIBLE W/1001%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secoMarytook 1. BARE STEEL Pq3. FIBERGLASS/PLASTIC U 5. CONCRETE 0 95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W1100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING 0 1.RUBBER LINED 0 3.EPDXY LINING 195.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Checkencimmonly) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC X 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN �8 DATE INSTALLED QW PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER i (Check oM itan ohly) ❑2 SACRIFICIAL ANODE (For Weal use only) SPILL AND OVERFILL YEARINSTALLED 450 TYPE(locduaeonly) 451 OVERFILL PROTECTION EQUIPMENTNEAR INSTALLED I -Z, 452 (Chwkalldol."Iy) J41 SPILL CONTAINMENT 0 ALARM 9(3 FILL TUBE SHUT OFF VALVE IM 2 DROP TUBE ❑2 BALL FLOAT ❑4 EXEMPT Q!L3 STRIKER PLATE IV.TANK LEAK DETECTION(A deetription ofine monitoring program shall o summiaedto the local agency.) IF SINGLE WALL TANK(check all tot apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Chock one item only) [31 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) 0 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE I,2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.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? 451 gallons ❑Yes ❑ No UPCF(12/99 revised) 10 Formerly SWRCB FofD1 B