BILLING_1997-2003 - Laserfiche WebLink

Home Browse Search

r IED PROGRAM CONSOLIDATED FOR TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page-of TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT S 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (spedfy reason-for local use only) ❑ 8 TANK REMOVED 430 FACILITY ID: 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 7-Eleven#32190 S� LOCATION WITHIN SITE(optional) 43t 4943 S. State Route 99, Stockton, CA ON (A sc 1.TANK DESCRIPTIaled plotplanwith 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 ® No 434 A05/56 Xerxes if-yes',complete one page for each compartment. ATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 6/2003 15,000 ADDITIONAL DESCRIPTION(For local use only) 436 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ®1. MOTOR VEHICLE FUEL Sia. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (8 marked complete Petroleum Type) 01b. PREMIUM UNLEADED ❑3. DIESEL 06. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER 3. CHEMICAL PRODUCT 441 CAS#(from Hazardous Matenals Inventory Page) 444 ❑ COMMON NAME (from Hazardous Materiels Inventory page) ❑4. HAZARDOUS WASTE Gasoline (includes Used oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3.SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN 02. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank [11. BARE STEEL 3. FIBERGLASS/PLASTIC [16. CONCRETE ❑85. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS S 8. FRP COMPATIBLE W/ [199.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANKMATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE 095. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS S 8. FRP COMPATIBLE [199.OTHER REINFORCED PLASTIC(FRP) W1100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 446 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Far local use only) (Check one item only) 448 DATE INSTALLED 449 OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 461 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (check all S 1 SPILL CONTAINMENT .200.3 ❑1 ALARM S 3 FILL TUBE SHUT OFF VALVE that apply) - 9 2 DROP TUBE 2003 ❑2 BALL FLOAT ❑4 EXEMPT S 3 STRIKER PLATE 2003 IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.). IF SINGLE WALL TANK(Checkall that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item 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 S 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 CLOSUREINFORMATIONY PERMANENT CLOSURE IN PLACE 455 ESTIMATED ESTIMATED DATE LAST USED(YR/MO/DAY) REMAINING QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 gallons 0 Yes ❑ No UPCF (1/99 revised) Formerly SWRCB Form B