BILLING - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM ' //) I G7L" TANKS UNDERGROUND STORAGE TANKS -TANK Ppages per ank 0 Papa _ pol\ TYPEOFACTION ❑1.NEW SITE PERMIT 0 4.AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) 0 B. TEMPORARY SITE CLOSURE 1y1^J (Check am".only) 0 7. PERMANENTLY CLOSED ON SITE V' 03.RENEWAL PERMIT (Spectyleason-rorlonluse Dory) (SpaciycmWe-brloaal use only) xe.TANKREMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Dalnp Business As) FACILITY ID N 1 1 � PArff r� S L ION WITHIN SITE(O 0 43 ve- 1.TANK DESCRIPTION TANK IOM TANK MANUFACTURER COMPARTMENTALIZED TANK 13 Yes 13 No II'Yai,complete ons papa M earJl mmpaRment DATE IN!SSIALLEEDD(YEA IRiMO)) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS ADDITIONAL DESCRIPTION(FarNxal use(nry) 11.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 1. MOTOR VEHICLE FUEL 0 Is. REGULAR UNLEADED ❑ 2. LEADED ❑ 5.JET FUEL (If ao, a compMb Pvoosam Type) 01b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 5. AVIATION FUEL 0 2, NON-FUEL PETROLEUM [:I u. MIDGRADE UNLEADED 0 4. GASOHOL 099. OTHER D 3. CHEMICALPRODUCT COMMON NAME(hom Hazaadu Maledals lmantWP4") CAS 0 Qmm Hazanlous Melenals lnkentcry Ppe) 0 4. HAZARDOUS WASTE(Includes Used aq 95 UNKNQM .TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL777WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEMR MEMBRANE LINER 095. UNKNOWN(Check arra kem Dory) 0 2. DOUBLE WALLWALL IN A VAULT ❑89. OTHERTANK MATERIAL-prmary tank 0 1. BARE STEELASS/PLASTIC D 5.CONCRETE 095. UNKNOWN (Check arra dem ony) D 2. STAINLESS STSTEEL CILAD RCED P/IFIBERI.ASTIC ILASS 0 B. FRP COMPATIBLE W/10U%METHANOL 099. OTHER TANK kUTERIAL-secondary lank 0 1 BARE STEEL ❑ 3. FIBERGLASS,PLASTIC 0 e. FRP COMPATIBLE W/100%METHANOL 085. UNKNOWN (Check one Nem any) 0 2. STAINLESS STEEL 0 4. STEEL CIAD W/FIBERGLASS 0 9. FRP NONCORRODISLE ACKET _ 099. OTHER REINFORCED PLASTIC(FRP) [110, COATEO STEEL ❑ S.CONCRETE DATEINSTALLED TANK INTERIOR LINING ❑ i. RUBBER LINED 133. EPDXY LINING ❑ 5.GLASS UNING 095. UNNNOWN433 OR COATING ❑ 2. ALKYD LINING Cl 6. PHENOLIC LINING ❑ S. UNLINED D 89, OTHER Forlmal use on (Oheak one from a DATE INSTALLED OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 095. UNKNOWN 434 PROTECTION IF APPUCABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Fsrlocaluu Dory) (Checkoneifam0*) ❑ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(Forhsal use any) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Cmakatllhalapply) ❑ 1, SPILL CONTAINMENT 0 1.ALARM 0 3. FILL TUBE SHUT OFF VALVE 0 2. DROP TUBE 02 BALL FLOAT_ 0 4. EXEMPT ❑ 3. STRIKER PLATE IV.-TANK LEAN DETECTION ' E ell theta ): IF DOUBLE WALL TANK OR TANK WITH BLADDER(Cmak ane dem aaWl IF SINGLWALL TANK Check ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLYI 0 2. AUTOMATIC TANK GAUGING(ATG) ❑ S. VADOSEZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING 0 3. CONTINUOVSATG 07. GROUNDWATER ❑ 3. MANUALMONITORING 0 4. STATISTICALINVENTORYRECONOLIATION(SIR)- ❑ B. TANKTESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED OATE LAST USED(YRIMOIDAY) ESTIMATED QUANTITY OF SUBST CE REMAINING 435 TANK FILLED WITH INERT MATERIAL? geu.m D Yes 0 No Formerly SWRCB Form 8 CUPAFORM(4/99)