BILLING - Laserfiche WebLink

Home Browse Search

U-,-.!T'IED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 l �� two ages tank) Page-of_ TYPE OF ACTION NEW SITE PERMIT ❑ 4 AMENDED PERMIT C1 CHANGE OF INFORMATION C36 TEMPORARY SITE CLOSURE (ch k-item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specilyreason-for local use only) (Specify reason-for local ase only) ❑ 8 TANK REMOVED 430 B�$INESS NAME(Same as FACILRY NAME or DBA-Doing Busineas As) FACILITY ID: GrLToT� 3 ;. _ . LOCATION WITHIN SITE(Optional) /f/o fz T- _ 431 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.) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes o 434 -rA (/ © If"Yea",complete came page for each comparwent. DATE INST LLED(YE O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIPTION(For local use only) 438 It.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ❑1. MOTOR VEHICLE FUEL ❑I& REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL 440 (JIfmprked complee Pwoletaa Type) ❑1 b PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL (2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL &J:�&OTHER ,e_ ;SLC Sf ❑3. CHEMICAL PRODUCT COMMON NAME(from Hea)dow Mata als Inventory page) 441 CAS#(from Hammlous Materials Inventory page) 442 Cl 4. HAZARDOUS WASTE (Include Used Oil) ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 3. SINGLE WALL WITH C1 S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chest one item only) EXTERIOR MEMBRANE LINER [195. UNKNOWN ❑2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank ZL BARE STEEL Ll 3. FIBERGLASS/PLASTIC 0 S. CONCRETE Lj 95. UNKNOWN 444 (Check one iron only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-se Bary tank Lj 1. BARE STEEL 03. FIBERGLASS/PLASTIC 0 5. CONCRETE 95. UNKNOWN q45 (Check one itau only) ❑2. STAINLESS STEEL C]4. STEEL CLAD W/FBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER N/�/ REINFORCED PLASTIC(FRP) ❑10.COATED STEEL f� ❑5.CONCRETE TANK INTERIOR LINING Ll 1.RUBBER LINED Lj 3.EPDXY LINING 0 S.GLASS LINING U 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LININGUNLINED ❑99 OTHER v� (Check one item only) A (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER U�j(- (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(iocai 111e owy) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ttt apply) ❑1 SPILL CONTAINMENT ❑1 ALARM ❑3 FILL TUBE SHUT OFF VALVE ❑2 DROP TUBE �� ❑2 BALL FLOAT i ❑4 EXEMPT ❑3 STRIKER PLATE L IV.TANK LEAK DETECTION(A description of the mowwring program shall be aubmined to the local agency.) IF SINGLE WALL TANK(Cheek all thatapply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) I VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ❑2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING [:199 OTHER rV.TANK CLOSURE INFORMATION/'PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 (� Ti(.4 C�gallons ❑Yes No UPCF(12/99 revised) 10 Formerly SWRCB Form B