Laserfiche WebLink
711FIED PROGRAM CONSOLIDATED FORlF" <br />UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br />TYPE OF ACTION 01. NEW SITE PERMIT 0 A AMENDED PERMIT <br />(Check one Bam a,*) <br />03. RENEWAL PERMIT I9nraMiiaaam-wMslvu oriM <br />0 S. CHANGE OF INFORMATION) <br />lSPeeYY pM15a -ro.row aa. oNy) <br />TANKS <br />(MD pages,ar tank) <br />Page _ of <br />0 S. TEMPORARYSITECLOSURE <br />0 T. PERMANENTLY CLOSED ON SITE_ ` <br />0 8, TANK REMOVED 430 /101, <br />BUSINESS NAME (Srm as FACIl1TY NAME wDBA - Doklp BuaHaaa Aa) <br />FACILITY ID F <br />3 P� <br />LOCATION WITHIN SITE (UPeetea 431 <br />I. TANK DESCRIPTION <br />TANK ❑ Yo ❑ No <br />TANK IDIII <br />TANKMANUFACTURER <br />CpMPARTMENTAl12E0 <br />1 <br />d <br />II-Yaf, comDlate ana Da9e ror aetli compWnent. <br />D <br />0 <br />DATE INSTALLED 0 FUMO) <br />TANK CAPACITY IN GALLONS <br />NUMBER OF COMPARTMENTS <br />I <br />DOD <br />ADDITIONAL DESCRIPTION (Fwbcal uas oMy) <br />II. TANK CONTENTS <br />SE 432 <br />-------------------- <br />PETROLEUM TYPE <br />0 2. LEADED <br />❑ 5. JET FUELafrpbum <br />FUEL <br />Type) <br />0X REGULAR UNLEADED <br />015. PREMIUM UNLEADED <br />0 3. DIESEL <br />❑ 8. AVIATIONFUELETROLEUM <br />!1.CLE <br />FVEHIC� <br />01a MIDGRADE UNLEADED <br />0 4. GASOHOL❑eB. <br />OTHERRODUCT <br />COMMON NAME (/mil HazallouoMatemarlaienfryPapa) <br />CAS 8 fta, Hara*K,a MahneH lnkentM page) <br />WASTE (Ircl - <br />111. TANK CONSTRUCTION <br />TYPE OF TANK 1, SINGLE WALL <br />0 3. SINGLEWALLWITH <br />0 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br />(Check oM dem PNy) DOUBLE WALL <br />EXTERIOR MEMBRANE LINER <br />'04 <br />095. UNKNOWN <br />SINGLE WALL IN A VAULT <br />0 N OTHER <br />TANFMATERAL-primarylanA 0 1 BARESTEEL <br />3. FIBERGLASS I PLASTIC <br />05 CONCRETE ❑ 95. UNKNOWN <br />(Clwck ane"nI wYy) 0 2. STAINLESS STEEL <br />�g0� <br />. STEEL CLAD WIFIBERGLASS <br />0 B. FRPCOMPATIBLEW/100%METHANOL ❑99. OTHER <br />! REINFORCED PLASTIC FRP) <br />TANK MATERIAL -..Wry tank 0 1 SARESFEEL <br />0 3, FIBERGLASS I PLASTIC <br />0 B. FRP COMPATIBLE W/1M%, METHANOL 095. UNKNOWN <br />(Check orH dem anty) ❑ 2. STAINLESS STEEL <br />STEEL CLkDWM8ERGIASS <br />0 9_ FRP NON -CORRODIBLE JACKET 099. OTHER <br />REINFORCED PLASTIC (FRP) <br />010 COATED STEEL <br />0 5. CONCRETE <br />TANK INTERIOR LINING 1, RUBBER LINED <br />0 3. EPDXY LINING <br />05. GLASS LINING 085. UNMONM433 DATE INSTALLED <br />OR COATING <br />❑ 2. ALKYD LINING <br />❑ 4. PHENOLIC LINING )KtUNLINED [IN. OTHER (Fwboa/ua10n <br />Check ons dam <br />OTHER CORROSION 1 MANUFACTURED CATHODIC <br />0 3. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 431 GATE INSTALLED <br />PROTECTION IF APPLICABLE PROTECTION <br />❑d. IMPRESSED CURRENT <br />N. OTHER <br />R:neck one aem onM ❑ 2. SACRIFICAL ANODE <br />(Fwbcal uH Doty) <br />SPILL AND OVERFILL <br />YEAR INSTALLED <br />TYPE (For uaa oNy) <br />OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED <br />(ChackaalMtappw <br />❑ 1. SPILLCONTAINMENT <br />0 1. ALARM 0 3. FILL TUBE SHUT OFF VALVE <br />0 2. DROP TUBE <br />r a <br />0 2. BALLFLOAT 0 4. EXEMPT <br />0 3. STRIKER PLATE <br />' <br />IV. TANK LEAK DETECTION <br />IF SINGLE WALL TANK(Check ag lhof a ) <br />IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check ane Ilam o ): <br />0 1, VISUAL ("POSED PORTION ONLY) <br />0 S. <br />MANUAL TANK GAUGING(MTG) <br />0 1. VISUAL (SINGLE WALLIN VAULT ONLY) <br />0 2. AUTOMATIC TANK GAUGING (ATG) <br />0 S. <br />VADOSE ZONE <br />2. CONTINUOUS INTERSTITIAL MONITORING <br />0 3. CONTINUOUSATG <br />0 ?. <br />GROUNDWATER <br />0 3. MANUAL MONITORING <br />0 4. STATISTICAL INVENTORY RECONCILIATION (SIR) <br />0 B. <br />TANKTESTING <br />BIENNIAL TANKTESTING <br />099. <br />OTHER <br />V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br />ESTIMATED DATE UST USED (YRIk10IDAY) <br />ESTIMATED QUANTITY OF SUBSTANCE REMAINING <br />435 TANK FILLED WITH INERT MATERIAL? <br />pallona <br />0 Yea 0 No <br />&*ioI Av, <br />CUPAFORM (4/99) lke.., Formerly SWRCB Farm 8 <br />