Laserfiche WebLink
- Now <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION-TANK INFO�M <br /> tBUSfNE:S;SIIEE7 <br /> CTION (Check one item only Fora UST closure or semovu/complete only this section and Secttonx I./( ////may �6eO (fie form per U$'o <br /> PERMIT ❑ 3.RENEWAL PERMIT <br /> PORARY UST CLOSURE 7.UST PERMANENT CLOSURE ONSITE ® 5.CHANGE OF INFORMATION <br /> PERMANENTLY CLOSED' 8,UST REMOVAL <br /> 43DATE EXISTING UST DISCOVERED: 45anD#(Agency I/,5e Only) L FACILITY INFORMATION <br /> AME(Sam¢as Facility Name or DBA-Doing Busirreu As/ 4 8 0 1oro 68222SS SITE <br /> ADDRESS <br /> 2132 an osa Rd. 0' CITY <br /> Stockton Io5 <br /> TANK ID# II. TANK DESCRIPTION <br /> a13 TANK MANUFACTURER 43a <br /> I TANK CONFIGURATION:THIS TANK IS va <br /> Modem Welding ® 1 ASTAND-ALONE TANK CaeWue otic <br /> DATE UST SYSTEM INSTALLED 435 TANK CAPACITY INGALI.ONS u6 TONE INA COMPAR'R.¢NTED UNIT _ was furx6 <br /> UnknoWB 12,0NUMBER OF COMPARTMENTS IN THE UNIT m�6[�nt437 <br /> 00 I <br /> III. TANK USE AND CONTENTS <br /> TANK USE ® Ia-MOTOR VEHICLE FUELING <br /> ❑ 3 CI IEMICAL PRODUCT STORAGE - 1 b.MARINAFUELING ❑ Ic.gVIATION FUELING <br /> ❑ 6_OTHER GENERATOR FUEL 04'HAZARDOUS WASTE I IaIuani ❑ 5.EMERGENCY GENERgTOR FUELIF15C yy52at 5(rl)9 <br /> CONTENTS_-PETROLEUM: 13 95 UNKNOWN _ ❑ 99.OTHER(Spw� <br /> ® la REGULAR UNLEADED <br /> ❑ 3.DIESEL ❑ ic.ET FUENHDGL ADE UNLEADED ❑ ib.PREMIUM UNLEADED aJ9i <br /> --__-_._._ O S.PETROLEUM BLEND FUEL � 3.)ET FUEL ❑ 6.AVIATION GAS �o <br /> -_-- <br /> NON-PETROLFUMr Q-],USED OIL --�--- O..ETHANOOLEUM�(y): aaos <br /> ❑ I1.OTHER NON-PETROLEUM s if <br /> IV. TANK 90b <br /> TYPE OF TANK CONSTRUCTION <br /> ----__ __._ I SINGLE WALL ® :,pOUBLE WgLI ❑ 95.UNKNOWN <br /> PRIMARY CONTAINMENT' ® t.STEEL ____._-____ _.._ _._ .. <br /> ❑ S.FIBERGLASS ❑ 6.INTERNAL BLADDER..____-___. <br /> w <br /> O ].STEEL.INTERNAM.LINING _ "---"--- <br /> SECONDARYCONTAINMENT - _-___..__.._0 93_UNKNOWN_ ❑ 99.OTHER_ µ <br /> ❑ L STEEL ❑3.FIBERGLASS 6,EXTERIOR MEMBRANE LINER(sE!CL : <br /> ___---- .______❑ 9.NONE ____ ❑ 95.UNKNOWN ® ]JACKETED u5 <br /> OVERFILL PREVENTION ® I AUDIBLEiivlsUAl ALARMS "-- �99.077IFR(S�xify): <br /> ® 2.BALL FLOATa51L <br /> 3,FILL TUBE sur-o" <br /> 4.TANK MEETS RE UIREMENTSTORE XEMPTION FROM OERFI O PREVENTION ENII UPMENTALE is2 V. PRODUCT/WASTE PIPING CONSTRUCTION <br /> PIPING CONSTRUCTION LJ JS INGLE WALL <br /> SYSTEM TYPE - - ® 2.DOUBLE WALL O 99.OTHER <br /> PRIIMARY CONTAINMENT - ® 1 PRESSURE -Q z cRAvrrY <br /> O l_CONENTION_A_L_S_UCTION---- --- - <br /> ❑ I STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ---1 4'SAFE SUCTION D CCR <br /> ❑ W NO ❑ 95.UNKNOWN ❑ I0.RIGID PLASTIC 464 <br /> SECONDARY CONTAINMENT ❑ L STEEL ❑ 99.OTHER(SPedfy)_.. <br /> ❑ 4.FIBERGLASS _ -.._ . <br /> ❑ 90.NO O.95.UNKNOWN 8.FLEXIBLE -E3-,-. RIGID. PLASTIC <br /> PIPINGlfURBINE CONTAINMENT SIT TYPE �_ .OTHER 5 a� <br /> ® L SINGLE WALL - ( Peaty l'. a65c <br /> VI. YENT,VAPOR RECOVERY _ DOUBLE WALL ❑ 90.NONE <br /> VENT'PRIMARY CONTAINMENT ")AND RISER/FILL PIPE PIPING CONSTRUCTION aha <br /> --_-________ 0 I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE <br /> VENT SECONDARY CONTAINMEM .._-_--_______.-___-to-- <br /> _-_ _ _ __ __❑_99.OTHER ry 4a. <br /> _ ❑ LaTEEL _..___._,.. _(Sped ): <br /> VR PRIMARY CONTAINMENT __� 4.FIBERGLASS ❑ 10RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): a64t <br /> ❑ 1.STEEL ® 4.FIBERGLAS$ ❑ 10.RIGID PLASTIC 090_NONE aun <br /> VR SECONDARY CONfA1NMENT ❑ i.STEEL ❑ 4.FIBERGLASS O 99.OTHER(spalls): <br /> VENT PIPING TRANSITION SUMP TYPE -- ❑ lo.RIGID PLASTIC <br /> p 90.NONE ® 99.V IME t a�6r <br /> ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ( ��): MMI. <br /> RISER PRIMARY CONTAINMENT ® 1.STEEL -_ ® 90.NONE <br /> 4.FIBERGLASS ❑ 10.RIGH PLASTIC <br /> _ _ -_- ❑ 90.NONE 99.OTHER .----. <br /> RISER SECONDARY CONTAINMENT -- _ (Sprcify): <br /> _ ❑ 1 STEEL "---" <br /> ___ _ ❑ 4.FIBERGLASS -- --'---' ' <br /> -- ❑ 10.RIGID PLASTIC <br /> FILL COMPONENTS INSTALLED � --�-'-------- _ ® 9o.NONE ❑ 99.OTHER(Specify} aha <br /> ® 3.STRIKER PLARLBOTTOM PROTECTOR <br /> ® I.SPILL Bl/CKET 4Nkt_. <br /> VII. UNDER DISPENSER CONTAINMENT(ND ® 4 CONTAINMENT SUMP 451< <br /> CONSTRUCTION TYPE ®_I.SINGLE WALL <br /> ❑ 2.OOUBLF WALL <br /> CONSTRUCTION MATF,RIAL -- - - ❑ 3.rvO DISPENSERS n <br /> ❑ L STEEL ❑ 4 FlBFRGLAS$ _ "- --t'-�-NONE __- 46e9pa. <br /> ® 10.RIGID PLASTIC - ❑ 90.OTHER(Specify) <br /> STEEL COMPONENT PRVIII. CORROSION <br /> OTECTION ❑ ?,SACRIFICIAL ANODEJS) <br /> PROTECTION <br /> ❑ 4.IMPRESSED CURRENT ® 6.ISOLATION <br /> IX. APPLICANT SIGNATURE`' <br /> CERTIFICATION; I certify that this UST aysrem Iscompartble with the bsnrdous substance stored and chat the information provided herein is (me,antl in lull eon fiance with legal re uiremenss. <br /> APPLICANT SIGNATURE <br /> , )a.`d 3 DATE 11/5/210 <br /> APPLICANT NAME(print) y CT. <br /> Sand Ed ards °]I APPLICANT Environmental Compliance <br /> 47.1 <br /> UPCF UST-8 Rev.(122000)_L/2 <br /> "W.R01d0CL0rg <br />