Laserfiche WebLink
Q ..FIED PROGRAM CONSOLIDATED FOR-i- <br /> 2�tages <br /> p <br /> da UNDERGROUND STORAGE TANKS - TANK PAGE i TANKS <br /> per tank) <br /> E OFAC77ON �]CLNEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION Page_of_ <br /> ( aos item ally) <br /> YJ/ ❑ 6 TEMPORARY SITE CLOSURE <br /> ❑ 7 PERMANENTLY CLOSED ON SITE <br /> 13-3-IfENEWAL PERMIT (Specify rca -for local we only) (Specify ream-to local uae only) ❑ 8 TANK REMOVED 430 <br /> Z)CfeE(S OA yME or DBA-Doing Buainesa/u) FACILITY ID: <br /> �J Tf 3 _ <br /> LOLLET <br /> CATION WITHIN SITE(Opt ones) <br /> O 4 � __ 431 <br /> I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) <br /> TANK ID# 432 TANK MANUFACTURER 433 <br /> 8 K UFA COMPARTMENTALIZED TANK Yes o 434 <br /> If"Yu",coegplete orae page for each co n xuto ew, <br /> DATE INST LLED(Y O) 435 TANK CAPACITY IN GALLONS 4M <br /> (✓� NUMBER OF COMPARTMENTS 433 <br /> �v <br /> ADDITIONAL DESCRIPTION(For lord we only) <br /> Cli <br /> II.TANK CONTENTS <br /> 7CHENUCAL <br /> 439 PETROLEUM TYPE <br /> ICLE FUEL ❑la. REGULAR UNLEADED 440 <br /> ❑2. LEADED ❑5. JET FUEL <br /> okwn Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL <br /> [16. AVIATION FUEL <br /> TROLEUM ❑1 c. MIDGRADE UNLEADED ❑4. GASOHOL �,OTHER <br /> RODUCT <br /> ❑4. HAZARDOUS WASTE CQMMON NAME (from iiaardou. er <br /> Ma a.Invcn G <br /> erypagc) 441 CAS#(fmmifazmJom Mataialslnvmwrypsge) 442 <br /> (Includes Used Oil) <br /> ❑95.UNKNOWN <br /> 111. TANK CONSTRUCTION <br /> TYPE OF TANK . SINGLE WALL J. SINGLE WALL WITH <br /> 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Chea one iwn only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN <br /> ❑2. DOUBLE WALL ❑4. SIONLE WALL IN VAULT ❑99. OTHER <br /> TANK MATERIAL-primary unk BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE <br /> 95. UNKNOWN 444 <br /> (Check ooc icon only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL <br /> ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL.-secadwy Lu 1, BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE <br /> 95. UNKNOWN 445 <br /> (Cheat one itan only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100°/.METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRP) [110.COATED STEEL <br /> ❑5.CONCRETE <br /> TANK INTERIOR LINING 1.RUBBER LINED 3.EPDXY LD4ING 5.GLASS LINING U 95.UNKNOWN 446 DATE INSTALLED 442 <br /> OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING UNLINED ❑99 OTHER <br /> (Check one item only) <br /> (For local a only) <br /> OTHER CORROSION ❑]MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER Ual�f" <br /> (Chert one ivy only) ❑2 SACRIFICIAL ANODE <br /> (For local-c only) <br /> SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local nae only) 451 OVERFILL PROTECTION EQU:OR <br /> :YEAR INSTALLED 452 <br /> (Check.11autapply) ❑1 SPILL CONTAINMENT <br /> ❑2 DROP TUBE ❑I ALARM LL TUBE SHUT OFF VALVE <br /> ❑2 BALL FLOAT i EMPT <br /> 3 STRIKER PLATE �IV.TANK LEAK DETECTION(A description ofthe monitoring program.hall be mlimined w ahe locIF SINGLE WALL TANK(chert.B thu.pply) 453 IF DOUBLE WALL TANK TANK WITH BLADDER 454 <br /> ClMTO I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING (Choat one a�on] ) <br /> ( ) C11 VISUAL(BINDLE WALL IN VAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATO) ❑6 VADOSE ZONE ❑2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) BIENNIAL TANK TESTING ❑99 OTHER ✓1�� <br /> N.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 452 <br /> l� Ti(i4 C gallons ❑Yes PANo <br /> UPCF(12/99 revised) 10 Formerly SWRCB Folin B <br />