BILLING 2010 - 2012 - Laserfiche WebLink

Home Browse Search

IED PROGRAM CONSOLIDATED FO UNDERGROUNDSTORAGETANK l OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 4 11,111,1V,and IX below) 430. Er 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ S.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4302. DATE EXISTING UST DISCOVERED: 4301,. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ _ 7 1 9 L BUSINESS NAME(Same as Facility Name or DBA-Doing Business AIN) ( a Mf O T-ffCA KW t K Soz\i BUSINESS SITE ADDRESS CITY 104. 824 u ' ycwrAr t= ACJ 103. MA"TECA , CA - �►533l� IL TANK DESCRIPTION TANK ID# 5' O 432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. S'l.A STAND-ALONE TANK Compiete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437, 1P_I000 1 III. TANK USE AND CONTENTS TANK USE Bt In.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ It.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Wed Oil ❑ 5.EMERGENCY GENERATOR FUEL[HSC p25281,5(c)] ________ ,❑ 6yR7:HER GENERATlaR FUEL _ _❑ 95.UNKNOWN _ _❑ 99.OTHER(Specify): 439e. CONTENTS PETROLEUM: .REGULAR UNLEADED ❑ tc.MIDGRADE UNLEADED ❑ Ib PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS I ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 4402. _---------- .....___.__ __.__.. ______. .............. .__........ ... .... _......_____ _..__....___,.,.. NON-PETROLEUM. 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406. • IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN 443. .... .... .... ._ _. __ PRQv1ARY CONTAINMENT 1 STEEL ❑ 3 FIBERGLASS ❑ 6 INTERNAL BLADDER � 444 7 STEEL+INTERNAL LINING ❑ 95 UNKNOWN ❑ 99 OTHER(Specify): 4442 __�, ._._ ___-__ ...._.. ._. - SECONDARY CONTAINMENTt90. 1.STEEL [13.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify). 445a. OVERFILL PREVENTION [3 ].AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOATSC 3.FILL TUBE SENT-OFF VALVE 452. [14.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFfLL_PREVENTION EQUIPMENT V. PRODUCT /WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1 SINGLE WALL 2 DOUBLE WALL ❑ 99.OTHER 460. _SYSTEM TYPE F�C/�-1 PRESSURE 0 2__GRAVITY _f 3.CONVENTIONAL SUCTION ❑,4 SAFE SUCTION 123 CCR 42636(a)(3)] 458 Y•._._...______ ___________ _ - ......_.._ PRIMARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ B FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 960a. ___...._..______-__________..... ..._...__..__._______ _____________..._ SECONDARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464.. PIPING/TURBINE CONTAINMENT SUMP TYPE 41.SINGLE WALL ❑ i1 6ABLE wALL ❑ 90.NONE 4644 VI. VENT, VAPOR RECOVERY(VR) AND RISER/ FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 4&L STEEL K 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): q4"n, .._. ____ ......... _. _ .... ......_.__ .__ .... ___._ VENT SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC 90.NONE ❑ 99 OTHER(Specify): �4171f VR PRIMARY CONTAINMENT ❑ I.STEEL syr 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHERS a 6 VR SECONDARY CONTAINMENT ❑ I STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC IK 90 NONE ❑ 99.OTHER(Specify): 4"hI _ .... . ........_----_.............. .. ............ . ...... .----- ......__..... . ........................... .........._______ ..06Ji. VENT PIPING TRANSITION SUMP TYPE ❑ L SINGLE WALL ❑ 2.DOUBLE WALL X 90.NONE _ ____________________ . . __- RISER PRIMARY CONTAINMENT f I STEEL [1 4.FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify). gbp4j' ________________._. . RISER SECONDARY CONTAINMENT ❑ 1 STEEL ❑ 4 FIBERGLASS ❑ 10 RIGID PLASTIC 90 NONE ❑ 99.OTHER(Specify): 464kI ......__..________�____ _____________________.____._________ ........___-.________ ._...._.____________ __._ FILL COMPONENT STALLED .SPILL BUCKET 3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451.. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE 1 SINGLE WALL 0 2 DOUBLE WALL ❑ 3 NO DISPENSERS ❑99:N ON4692. ....._______________._ ......... ... ............- ........ ................. ..... ........... --- . _..____. '2... .4696.,... CONSTRUCTION MATERIAL ❑ I.STEEL �-4 FIBERGLASS ❑ 10 RIGID PLASTIC ❑ 99.OTHER(Specify) 3.-s 469, VIII. CORROSION PROTECTION " -•-nne STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 440 IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provide ein is true, accurate,and in fg1coul with le al re uirements. APPLICANT SIGNATURE DATE O ' 470. APPLICANT NAME(print) 471 1 APPLICANT TITLE 472. UPCF UST-B Rev.(12/2007).1/2 www.unidocs.org