BILLING 2004-2008 - Laserfiche WebLink

Home Browse Search

J 1 ONMED PROGRAM CONSOLIDATED 4PM Wql6 0� UNDERGROUND STORAGE TANK r OPERATING PERMIT APPLICATION-TANK INFORMATION(One form per UST) TYKE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections L R,RI,IV,and IX below) 030 [v7 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: 430a DATE EXISTING UST DISCOVERED: 90b L FACILITY INFORMATION FACILITY ID H(Agency Use Only) _ - 1 3 17 1319 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Tower Mart#886 BUSINESS SITE ADDRESS 103 CTfY 109 1434 W.Yosemite Ave. Mmteca CA II.TANK DESCRIPTION TANK IDH MG-886 632 TANK MANUFACTURER 433 T.q.NVONFIGURATION: THIS TANK IS 434 Modern Welding LTJ 1.A STAND-ALONE TANK / / SOS ❑2.ONE IN A COMPARTMENTED UNIT. Com late we pw for each com M in the umt. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 433 Jan 1991 10,000 Gal One 1 11 M.TANK USE AND CONTENTS TANK USE la MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Ue Oil) ❑ 5.EMERGENCY GENERATOR FUEL(HSC§25281.5(c)1 ❑ 6.OTHER GENERA OR FUEL ❑ 95.UNKN ❑ 99.OTHER (Specify): 43% CONTENTS PETROLEUM: ,/L a.REGULAR UNLEADED lc.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ S.JET FUEL ❑ &AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM S 110. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTIID2NON-PETROLEUMS 4Ob IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT 1.BTEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN [199.OTHER (specify): 441a SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 45 ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Speci : 415a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS U 2.BALL FLOAT 3.FI.L TUBE SHUT-OFF VALVE 452_ ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑L SINGLE-WALLED 2.DOUBL&WALLED ❑99.onfER 169 SYSTEM TYPE V 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§263 s 3I 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ I0.RIGIDPLASTIC 664 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OITIBR(Specify): 464 SECONDARY CONTAINMENT ❑ 1.STEEL Er 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 5.UNKNOWN ❑ 99.OTHER(Specify): 464 PIPINGfTURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464 VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT LLY 1.STEEL ❑ 4.FIBERGLASS Lj 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464 44e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464f 464n VR PRIMARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 4w a VR SECONDARY CONTAINMENT ❑ L STEEL 0 4.FIBERGLASS ❑ 10.RIGIDPLASTIC 0 90.NONE ❑ 99.OTHER(Specify) 464h O hl VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WAIL 2.DOUBLE WAIL ❑ 90.NONE 164E RISER PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 4644 464'1 RISER SECONDARY CONTAINMENT 0 1.STEEL ❑ 4.FIBEI!qLASS ❑ 10.RIGID PLASTIC 0 90.NONE ❑ 99.OTHER(Specify) 464k 464kl FILL COMPONENTS INSTALLED ff 1.SPIN BUCKET Eir 3.STRIKER PLATEIROTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451. VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE 1.MM DOUBLE DOUBLE WALL ❑ 3.NO DISPENSERS [190.NONE 469a CONSTRUCTION MATERIAL [11.STEEL ❑ 4.FIBERGLASS 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696.c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION as. DL APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true,accurate, and in full compliance with legal requwments. APPLICANT SIGNATURE O DATE 3/3/08 °'0 APPLICANT NAME(print) Paul Chevalier 411. APPLICANT TITLE Maintenance Manager 472. UPCF UST-B-12 Rev.(12/2007)