BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM ulaI l °`i TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (Two pages per tank) TYPE OF ACTION ❑ 1.NEW PERMIT Page_of ❑ 4•AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check oee item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (specify reams) (Specifyreason) 8.TANK REMOVED BUS)NESS*�MME(samearepclurvTrAMe or -moms sumneae Ae) 3. FACILITY ID: LOCATION WITHIN SITE In lona- r loan - p� �1.R31. I.TANK DESCR ION - (A sealed lot Im-will tl-e location of the UST system incl--'---boildin sand Im-(Lnarks shall be submitted to the local agency.) TANK ID# 43'.. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK 7 0 7 ❑Yes No 4y(, DATE INSTALLED 43s. h If"Yea;'mmpleto one Pere for each compannmm. TANKPgCITY IN GALLONS 436. NUMBER we COMPAR NIS (YEAR/MO) //^ NN 433. ADDITIONAL DESCRIPTION(F.,total uu omy) / 438. D:TANK CONTENTS TANK USE 439. PE'CROLEUM TYPE ❑ 1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED 01. LEADED <w. unchecked,complete Petroleum Type) ❑5. AVIAT1 L ❑16. PREMIUM[NLEADED [13. DIES¢ ❑6. AVIATION GAS t� 2. NON-FUEL PETROLEUM ❑Ic, MIDGRADE UNLEADED ❑4. GASOHOL .OTHER: ❑ 3. CHEMICALPRODUCT COMMON NAME (Som Hmarde.manriw lnvemo 441, ❑ 4. HAZARDOUSWASTE ryPage) CAS#oom Hazardous Mmenalsmvemurypq 443, (includes Used Oa) �I 4i\ I -rt1 �a'S i ❑ 95.UNKNOWN ,Tew`� ('^�' UL TANK CONSTRUCTION TYPE OF TANK . SINGLE WALL ❑3. SL\GLE WALL WITp LKTF.RIOR ❑3, SA'GLE WALL WITII INTERNAL BLADDER SYSTEM J43. (Check one item ply) NEMRRANE LINER ❑2. DOUBLE WALL ❑96 UNKNOWN ❑4. SINGLE W ALL IN A VAULT ❑99. OTI-IER TANK MATERIAL_pyt -ARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 444. (Ch<ckon item omy) ❑2. STAINLESS STEEL ❑4. STE¢CLAD W/FIBERGLASS ❑B. FAP COMPATffiLE ❑99.OTHER: TANK MATERIAL- REINFORCED PLASTIC W/100%METHANOL secoMary tank I. HARE STEEL 3. FffiERGLASS/PLASTIC 8. FRP COIdPTffiLE W/100%METHANOL 95.UNKNOWN a45. (Check ore item only) ❑2. STAINLESS STEEL ❑4. STE¢CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET REINFORCED PLASTIC FRP ❑99'OTHER ( ) ❑10. COATID STEEL 5. CONCRETE TANK INTERIOR LAYING 1.RUBBER LINED 3.- LININGGLASS LINING 95. 446, DATE INSTALLED Ch UNKNOWN 447. COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING 6. N Chock am item aN UNLINED ❑99.OTHER OTHER CORROSION 1.MANUFACTURED CATHODIC ❑3.FffiERGLASS REINFORCED PLASTIC , 95.UNKNOWN 4qa DATE INSTALLED a4s. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER WA Iicable 2.SACRIICIAL ANODE SPILL AND OVERFILL YEAREYSTALLED 450. TYPE 451. OVERFILLPROTECTIONEQUIPMENT: YEARINSTALLED 451. (Check all that apply) ❑1,SPILL CONTAINMENT ❑1 ALARM ❑3 DROPSTRIKER PLATE �� -- [12.BALL FLOAT_ [1 4.EXEMPT TOFF VV V$- IV.TANK LEAK DETECTION (A-escri iiou of the monitorin ro am shall be submitted[o B-e local a ency) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK Wil 11 BLADDER 4s,I (Cluck all that apply) (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 ❑3. CONTINUOUS ATG [12.CONTINUOUS INTERSTITIAL MONITORING ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION [19.TANK TESTING /V ^ (SRR)+BIENNIAL TANK TESTING ❑99. OTHER /T V.TANK CLOSURE INFORMATION /PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455, ESTIMAT U 7y OFSUBSTANCEREMAINING 456. D / TANK FILLED WITH INERT MATERIAL? 451, gallons es ❑ No UPCF hwfwrc-b(1/99)-1/4 http://www.unidoes.org Rev.02/16/00