BILLING - Laserfiche WebLink

Home Browse Search

FA UNIFIED PROGRAM CONSOLIDATED FORM -rA UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYPE OF ACTION (Check one itcm only. For an UST permanent closure or removal,complete only this section and Sections 1,Il,111,IV,and IX below) 410 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ® 8.UST REMOVAL = DATE UST PERMANENTLY CLOSED: 43M DATE EXISTING UST DISCOVERED: 10/24/2012 439b L FACILITY INFORMATION FACILITY ID N(Agency Use Only) _ I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 CALTRANS Highway 26 Right of Way,State of California BUSINESS SITE ADDRESS 101 CITY IN N.E.corner of 19107 East Highway 26 Linden (Caltrans Right of Way) 11.TANK DESCRIPTION TANK IDN LIST-I-Linden 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 RHEEM ® 1.ASTAND-ALONETANK ❑2.ONE M A COMPARTMENTED UNIT. Com Ide we ern each com item in Ne unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 1922-1935 Approx.400- allons one III-TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMJCAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE B.dl Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HsC§252a1.5(c)] ❑ 6,OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99,OTHER (Spewify): 43% CONTENTS PETROLEUM: [I ]a.REGULAR UNLEADED ❑ IC.MIDGRADE UNLEADED ❑ Ib.PREMIUM USLEADED 440 El 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ® 9.OTHER PETROLEUM (Specify): Leaded Gasoline bm. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHERNON-PETROLEUM(Specify): 449b IV. TANK CONSTRUCTION TYPE OF TANK ® I.SINGLE WALL I7 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.IN"rERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LrMNG ❑ 95,UNKNOWN ❑ W OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ I.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7,JACKETED 445 ® 90.NONE ❑ 95.UNKNOWN ❑99.OTHER S i : 446+ OVERFILL PREVENTION ❑ I,AUDBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ❑ 3.FILL TUBE SHAT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ® 1.SINGLE-WALLED [12.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ❑ 1.PRESSURE ® 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 1➢CCR§2636(.X3)] 458 PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ® 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464. SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ® 90.NONE ❑ 95 UNKNOWN ❑ 99.07"HER(Specify): 464a PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALT. E9 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 19 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE El 99.OTHER(Specify) 464c 464.1 VENT SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER ISI clfy) 464f 464n VR PRIMARY CONTAINMENT ❑ I.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC ID 90.NONE ❑ 99.OTHER(Swify) Oma 4MRI VR SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Spaify) 464h w hl VENT PIPING TRANSITION SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL N 90.NONE 4641 RISER PRIMARY CONTAINMENT 0 I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) a6aj 464'1 RISER SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC Z 90.NONE ❑ 99.OTHER(Specify) 4644 46441 FILL COMPONENTS INSTALLED ❑ 1.SPILL BUCKET 3.STRIKER PLAI'EIBOTFOM PROTECTOR ❑ 4.CONTAINMENT SUMP i51a VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ L SINGLE WALT. ❑ 2.DOUBLE.WALL ❑ 3.NO DISPENSERS ® 90,NONE 469. CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4,FIBERGLASS ❑ 10.RIGID PLASTIC ® 99.OT1TER(Specify)none g69bc VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL Al ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 401 IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the havardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requirements. APPLICANT SIGNATURE !I/ �� DATE 10/14/2014 410 UPCF UST-B-113 /� Rev.(122007)