BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERAUND STORAGE TANKS - 16K PAGE 1 `V, (two pages per tank) page -of CLOSURE TYPE OF ACTION ❑ 1 NEW SITE PERMIT C7 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION❑� TEMPORARY SITE CLOSED ON SITE {Check one item only)430 ® 3 RENEWAL PERMIT (Specify reason - for local use only) (Specify reason - for local use onty) [� 8 TANK REMOVED 1 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY 1D: 3 � � t� -o 0 3 la_ ©� ►� Beacon Station #3492 431 LOCATION WITHIN SITE (Optional( I. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local a enc . TANK ID # �� 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 gl 5 7 TrUSCQ If'Yes,. complete one page for each compartment. 3492-1 l Flr © 43fi NUMBER OF COMPARTMENTS 437 DATE INSTALLED (YEARlMO) 435 TANK CAPACITY IN GALLONS 12198 14040 1 438 Fmarkedl AL DESCRIPTION (For Iccal use only) II. TANK CONTENTS 440 USE 439 PETROLEUM TYPE R VEHICLE FUEL ® 1a. REGULAR UNLEADED [12. LEADED ❑ 5. JET FUEL plelePetroleumType) ❑1b, PREMIUMUNLEADED ❑3. DIESEL ❑6. AVIATION'FUEL FUEL PETROLEUM ❑ 1C. MIDGRAOE UNLEADED [14, GASOHOL [199. OTHER [13. CHEMICAL PRODUCT441 CAS# (from Hazardous Materials Inventory page) 442 COMMON NAME (from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE 8006-61-9 (Includes Used Oil) [3 95. UNKNOWN III. TANK CONSTRUCTION 443 TYPE OF TANK ❑ 1. SINGLE WALL C33. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN Z2. DOUBLE WALL E14. SIGNLE WALL IN VAULT ❑ 99. OTHER 444 TANK MATERIAL -pnmary tank ® 1. BARE STEEL El 3. FIBERGLASS 1 PLASTIC ❑ 5. CONCRETE El 95. UNKNOWN (Check one item only) [12. STAINLESS STEEL [14. STEEL CLAD WIFIBERGLASS [18. FRP COMPATIBLE Wl ❑ 99. OTHER REINFORCED PLASTIC (FRP) 190°/ METHANOL TANK MATERIAL -secondary tank El 1, BARE STEEL ®3. FffiERGiASS 1 PLASTIC El 5. CONCRETE ❑ 95, UNKNOWN 445 (Check one Item only) ❑ 2. STAINLESS STEEL ❑ 4, STEEL CLAD WIFIBERGLASS ❑ B. FRP COMPATIBLE ❑ 99. OTHER REINFORCED PLASTIC (FRP) W1100% METHANOL [15, CONCRETE ❑ 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [:11. RUBBER LINED [__13. EPDXY LINING El5. GLASS LINING ❑ 95. UNKNOWN 446 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED Q 99 OTHER (For local use only) (Check one Item only) 448 DATE INSTALLED 449 OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC C1 9 UNKNOWN THER PROTECTION IF APPLICABLE PROTECTION ❑ 4 IMPRESSED CURRENT ❑ (For local use only) (Check one item only) I3 2 SACRIFICIAL ANODE 452 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check all ® 1 SPILL CONTAINMENT 1998 ® 1 ALARM El3 FILL TUBE SHUT OFF VALVE 2 DROP TUBE 1998 that apply} ❑ 2 BALL FLOAT [24 EXEMPT ❑ ® 3 STRIKER PLATE 1998 IV. TANKLEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) 454 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER IF SINGLE WALL TANK (Check all that apply) (Cneckone item only) E]1 VISUAL (EXPOSED PORTION ONLY) El MANUAL TANK GAUGING (MTG) C31 VISUAL (SINGLE WALL IN VAULT ONLY) 1-12 AUTOMATIC TANK GAUGING (RTC) ❑ 6 VADOSE ZONE ❑ 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 7 GROUNDWATER ❑ 3 MANUAL MONITORING ❑ 3 CONTINUOUS ATG ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER lV. TANK CLOSURE INFORMATION /PERMANENT CLOSURE IN PLACE 457 455 ESTIMATED QUANTITY flF SUBSTANCE a5fi TANK FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED (YRIMOIDAY) REMAINING ❑ Yes [j No gallons Formerly SWRCB Form B UPCF (1/99 revised)