BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

�IFIED PROGRAM CONSOLIDATED F ir TANKS UNDERGROUND STORAGE TANKS TANK PAGE 1 (two pages per tank) Page 5 of 6 TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT M 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one hem only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-forloal use only) (specify reason-for local use only) ❑ STANK REMOVED 430 BUSINESS NAME(Same M FACILITY NAME or DBA-Doing Business As) I 3 FACILITY ID: 0 0 0 0 0 <'. 0 0 0 0 0 0 Chevron Station#200764 LOCATION WITHIN SITE(optional) 431 4747 West Lane,Stockton CA 95210 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 N No 434 3 OWENS CORNING If-Yee',complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 9/28/90 12,000 0 ADDITIONAL DESCRIPTION(For local use only) 439 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® 40I. MOTOR VEHICLE FUEL [Ila. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (Iferarked contkne Petroleum Type) MIb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED 04. GASOHOL 099.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials inventory page) 441 CAS#(fmm Hazardous Materials inventory page) 442 ❑4. HAZARDOUS WASTE (Includes Used Dip PREMIUM UNLEADED 800-61-9 ❑95.UNKNOWN DI. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [13. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN Z 2. DOUBLE WALL ❑4. SINGLE WALL IN VAULT ❑99. OTHER_ TANK MATERIAL-primary tank ❑ 1. BARE STEEL Z3. FIBERGLASS/PLASTIC ❑5. CONCRETE 095, UNKNOWN 444 (Check ons hem only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W1100%METHANOL ❑99.OTHER_ REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tarok ❑1. BARE STEEL Z 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL [15. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING M 6 UNLINED ❑99 OTHER (Check one hem only) (For local uu only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC M 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 441 441 PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER (Check one dem only) ❑2 SACRIFICIAL ANODE (Forlocoluseanly) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) M 3 FILL TUBE SHUT OFF VALVE Z I SPILL CONTAINMENT 1990 M 1 ALARM OPW 61-SO-4 ®2 DROP TUBE 1998 GPW 61-SO4 ❑2 BALL FLOAT_ ❑4 EXEMPT ®3 STRIKER PLATE Tank Mf _ IV.TANK LEAK DETECTION(A description ofthe monitoring program shall he submittedto the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one hem only) ❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING (MTG) ❑ IVISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ASG) ❑6 VADOSE ZONE Z 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER _ IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE FFST ATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(1/99 revised) 177 Formerly SWRCB Form B