BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

a D PROGRAM CONSOLIDATED A • TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) f TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SrrS CLOSURE &j (Checkone awn only) ❑ 7 PERMANENTLY CLOSED ON SITE M ❑ 3 RENEWAL PERMIT (Spacifymason-forlocduseonly) (Spaifymmon- forlocal use only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Seme as FACILITY NAME or DBA -Doing Busmesa As) FACDRfY ID: n ` 1 1 3 1 D WS USA GASOLINE #65 S LOCATION WITHIN SITE (opeonap L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK []Yes E No 434 _ p> MODERN WELDING If"Yes^, complete one page for each oomparanent ATE INLLED (YEAR/MO) 435 STA TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 12,000 ADDITIONAL DESCRIPTION (For local we only) 438 U. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED [12.LEADED ❑5. JET FUEL (Ifmsrked complete Peholecn Type) [I 1b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATIONFUEL [12. NON -FUEL PETROLEUM ® Ic. MIDGRADE UNLEADED [14. GASOHOL ❑ 99. OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (S.. Hamrdow Menials lnvenWry page) 441 CAS#(from Hamrdom Materials looentory page) 442 [14 HAZARDOUS WASTE (Ncludea Used OI) [195. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK [11. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Checkoneitemonly) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN E 2. DOUBLE WALL [34. SIGNLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL-prminy tank ® 1. BARE STEEL 3. FIBERGLASS/ PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 (Check one item only) [12. STAINLESS STEEL [14. STEEL CLAD W/FISERGLASS ❑ S. FRP COMPTIBLE W/1000%METHANOL [199. OTHER REINFORCED PLASTIC (FRP) TANKMATERIAL-aecondarytank [11. BARESTEEL 3. FIBERGLASS/ PLASTIC 5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑ 2. STAINLESS STEEL ® 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/100% METHANOL ❑ 99. OTHER REINFORCED PLASTIC (1") ❑ 10. COATED STEEL ❑ S. CONCRETE TANK INTERIOR LINING 1. RUBBER LINED 3. EPDXY LINING 5. GLASS LINING 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ®6 UNLINED ❑ 99 OTHER (Deck one inn only) (Fmlocalwe only) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑ 4IMPRESSED CURRENT ❑ 99 OTHER (Cheek one inn only) ❑ 2 SACRIFICIAL ANODE (For local we only) SPILL AND OVERFILL YEARINSTALLED 450 TYPE (local we only) 45l OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check dl that apply) ®1 SPILL CONTAINMENT 1997 ® 1 ALARM 1997 ❑ 3 FILL TUBE SHIT OFF VALVE E 2 DROP TUBE 1997 ® 2 BALL FLOAT 1997 ❑ 4 EXEMPT E 3 STRIKER PLATE 1997 IV. TANK LEAK DETECTION (A description ofthemcna ringpro,wo shall be subrniwd to the local agency) IF SINGLE WALL TANK(Chackal thwtapply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one inn only) ❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (MTG) ❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING (ATG) ❑ 6 VADOSE ZONE ® 2 CONTINUOUS iiTmsTITLAL 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 4% TANK FILLED WITH MET MATERIAL? 457 gallons ❑ Yes ❑ No UPCF (1/99 revised) Formerly SWRCB Form B 1;/0 poi