BILLING_2013-2014 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. Foran UST permanent ciosureor removed,complete only this section and Sections 1,11,III,IV,and IX below) 430 ❑ L NEW PERMIT [13.RENEWAL PERMIT S.CHANGE OF INFORMATION yl �ll El 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: d30i I DATE EXISTINGUST DISCOVERED: 10/4/1 V dJ01' IuV_ L FACILITY INFORMATION FACILITY ID M(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Caltrans 3 BUSINESS SITE ADDRESS OOP 103 CITY Stockton 104 IL TANK DESCRIPTION TANK IDS Ih� Unknown 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 (ci [n I.ASTAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Com Kane fm esrA co,,IIbnent ie the wit DATE UST SYSL7FMo.NSTALLED 435 TANK CAPACITY IN GSOt.Oa S 436 1 NUMBER OF COMPARTMENTS IN THE UNIT 937 III.TANK USE AND CONTENTS TANK USE ❑ Is-MOTOR VEHICLE FUELING ❑ H.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE [J 4.HAZARDOUS WASTE(I.IWn Used 0,4 ❑ 5.EMERGENCY GENERATOR FUEL[Hsc 1252s1.5(cry ❑ 6.OTHER GENERATOR FUEL E3 95.UNKNOWN ❑ 99.OTHER (Specify): 439. CONTENTS PETROLEUM: ❑ Is.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATFN AS. [IS.PETROLEUM BLEND FUEL [19.OTHER PETROLEUM S ( : .ATF ents 44os NON-PETROLEUM❑ 7.USED OIL ❑ 10.ETHANOL ® 11.OTHER NON-PETROLEUM S eci . Unknown 44ab IV. TANK CONSTRUCTION 'TYPEOFTANK 0 I.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT 0 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (S ): 444e SECONDARY CONTAINMENT [11.STEEL ❑3.FIBERGLASS 6.EXTERIOR MEMRA BNE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN 14 99.OTHER(Specify) None 445. OVERFILL PREVENTION 0 L AUDIBLE&VISUAL ALARMS U 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT NONE V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SINGLE-WALLED [12.DOUBLE-WALLED ❑99.OTHER NONE460 SYSTEM TYPE ❑ 1.PRESSURE 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION D3 CCR g2636(aK3)) a5fi PRIMARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLAS'T'IC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 0 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specily): 469e PIPINGTURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL in 90.NONE 4644 Vl.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT L STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Sp-ty) 464e 464e1 VENT SECONDARY CONTAINMENT t3 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 46af 46,411 VR PRIMARY CONTAINMENT 1.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC El 90.NONE 99.OTHER(Specify) 4648 464'I VR SECONDARY CONTAINMENT I.STEEL 4.FIBERGLASS 10,RIGID PLASTIC El 90.NONE E3 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE 171 I.SINGLE WALL ❑ 2.DOUBLE WALL 90.NONE 4641 RISER PRIMARY CONTAINMENT Lj 1.STEEL ❑ 4.FIBERGLASS U 10,RIGID PLASTIC La 90.NONE U 99.OTHER(Specify) 4641 "I RISER SECONDARY CONTAINMENT 1.STEEL 0 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 4618 464k1 FILL COMPONENTS INSTALLED I.SPILL BUCKET 0 3.STRIKER PLATEMOTTOM PROTECTOR 4.CONTAINMENT SUMP UNKNOWN 451. VII. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE B 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469e CONSTRUCTION MATERIAL 13 I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99,OTHER(Spai ) 4696-c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6 ISOLATION 148. IX. APPLICANT SIGNATURE CERTIFICATION: i certify I at is UST system is mpafible with the hazardous substance stored and that the information provided herein is true,accurate, and in rul to pliance with al requirements. APPLICANT SIGNATURE DATE 10-17-13 470 APPLICANT NAME(print) Tim Lane n1. APPLICANTTITLE Director/Agent 47 UPCF UST-B-1/2 Rev.(12/2007)