BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UN.,IED PROGRAM CONSOLIDATED FORM ==TANKSLL . UNDERGROUND STORAGE TANKS -TANK PAG Page of 7 ❑ S. TEMPORARY SITE CLOSURE TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 7 PERMANENTLY CLOSED ON SITE (Check one item only) 3.RENEWAL PERMIT (Specify reason•for local use only) (Specify change-for local use only) ❑ 8. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID K 1 sT -e>en vtce-5 LOCATION WITHIN SITE(Ophonay 431 1.TANK DESCRIPTION TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes TANK IDN If'Yei,wmplete one page for each compartment, 0�/l�o�A/ NUMBER OF COMPARTMENTS DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS 0/✓iL,✓10w1✓ 000 ADDITIONAL DESCRIPTION(Forlocal use only) II.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 1 MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED FE4 LEADED ❑ 5. JET FUEL (If marked,complete Petroleum Type) ❑1b. PREMIUM UNLEADED DIESEL 6. AVIATION VEL❑ 2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED GASOHOL I99. OTHER/ ❑ 3. CHEMICAL PRODUCTCAS R(hom Hazardous Materials Inventory page) COMMON NAME(from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE(Includes Used Oil) F7 0L,&Z, yr & N e- /1lif`sc72 eV yK III.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM ,0 EXTERIOR MEMBRANE LINER [:195. UNKNOWN (Check one item only) L$2. DOUBLE WALL [3 4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tank1. BARE STEEL 93. FIBERGLASS I PLASTIC ❑ 5. CONCRETE C]95. UNKNOWN ❑ (Check one item only) ❑ 2. STAINLESS STEEL ❑4. STEEL FORLA D /FIBER LASS C38. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER REINFORCED TANK MATERIAL.secondary tank ❑ 1 BARE STEEL 3. FIBERGLASS/PLASTIC ❑ B. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN d ❑ 4. STEEL CLAD WIFIBERGLASS C:19. FRP NON-CORRODIBLE JACKET 99. OTHER (Check one item only) 13 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑ 5. CONCRETE DATE INSTALLED TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 OR COATING ❑ . 6. UNLINED ❑99. OTHER ❑ 2. ALKYD LINING 4PHENOLIC LINING (Forlocal use only) (Check one item onl) DATE INSTALLED OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 PROTECTION IF APPLICABLE PROTECTION ❑99. OTHER ❑ 4. IMPRESSED CURRENT (Forlocal use only) (Check one item only) ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED SPILL AND OVERFILL ,...s YEAR INSTALLED TYPE(For local use only) (Check all that apply) 11a 1 SPILL CCNTAINMENTT ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE �❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE W. TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item onl): IF SINGLE WALL TANK Check ell that apply) ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ S. VADOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING ❑ [17. GROUNDWATER 3. MANUAL MONITORING 3. CONTINUOUS ATG ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑ 8. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? gallons ❑Yes ❑No Formerly SWRCB Form B CUPAFORM(4/99)