BILLING 2001 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANK d UNDERGROUND STORAGE TANKS-TANK PAGE 1 1 (two pages per tank) Page TYPE OF ACTION 111.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ B. TEMPORARY SITE CLOSURE (Check ane item onyq ❑3.RENEWAL PERMIT ❑ ]. PERMANENTLY CLOSED ON SITE (Spedlymeaon-Torloaluaa.My) (Sperry chsnge-brla<al use only) ❑ 0. TANK REMOVED 430 BUSINESS NAME F�TYNAMJE D Business _ FACILITY ID0 1 C ((//��11 a.l//r�jt-J 651 "78 LOCATION WfTHIlY SITE(Op#arIMJ 431 I.TANK DESCRIPTION TANK 10# yATANK MANUFACTURER _ COMPARTMENTALIZED TANK ❑ Vas a aKI (+(-/7--✓D(h�1 IPYei,mmplete one page ter each com Mnent. DATE INSTALLED(YEARMO) TANK PACITYINGALLONS� NUMBER OF COMPARTMENTS 14000 ADDITIONAL DESCRIPTION(Forlccal use only) II.TANK CONTENTS TANK USE 432 PETROLEUM TYPEae/ ,� 1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED L{V2. LEADED ❑ 5. JET FUEL (IT manaq complete Patmleurrl TYPE) ❑lb. PREMIUM UNLEADED ❑ 3. DIESEL ❑ S. AVIATION FUEL ❑ Z. NON-FUEL PETROLEUM ❑1c MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3.CHEMICAL PRODUCT ❑ 4. HAZARDOUS WASTE(1n .des COMMON NAME @om Hazallous Matertals lnwnbrypage) CAS#prom H8md0ua Meterialslownherypage) Used O)q 1195 UNKNOVON III.TANK CONSTRUCTION TYPE OF TANK 1, SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ S. SINGLE WALL NTH INTERNAL BLADDER SYSTEM (CheckonaitemonW ❑ Z. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary lank X . BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5.CONCRETE 095. UNKNOWN (Check ors them only) ❑ Z, STAINLESS STEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ B. FRP COMPATIBLE Wil 00%METHANOL ❑99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-serond.q lank 11 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 0. FRP COMPATIBLE W/100%METHANOL El as. UNKNOWN-` (Check oneilem only) 13Z. STAINLESS STEEL 114. STEEL CLAD WIFIBERGLASS 119. FRP NON-CORRODIBLE JACKET ❑99. OTHER /V OLA, REINFORCED PLASTIC(FRP) 1110. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNONM433 DATE INSTALLED OR COATING Check oils item an ) 3.ALKYD LINING ❑ 4. PHENOLIC LINING . UNLINED ❑99. OTHER (Forbcel uae on OTHER PROTECTION IF ON ❑ 1, MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 DATEINSTALLED PROTECTION IF APPLICABLE PROTECTION �/_ �[Vk/ J 110. IMPRESSED CURRENT 9. OTHER t (Forloraluaeonly) (Check one them only) 112. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(Forbcal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED q( (Check aft that apply) 111 SPILL CONTAINMENT yrs �,�,.,� p ,I -F-4LL4 /✓�� ❑ 1.ALARM 3. FILL TUBE SHUT OFF VALVE ❑ Z. DROP TUBE ❑ 3. SALL FLOAT_ ❑ 4. EXEMPT ❑ 3. STRIKER PLATE k IV. TANK LEAK DETECTION IF SINGLE WALL TANK EChsok all that apply) IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one Rem only): ❑ 1, VISUAL(EXPOSED PORTION ONLY) 115. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) 13Z. AUTOMATIC TANK GAUGING(ATG) ❑ B. VADOSE ZONE ❑ 3. CONTINUOUS INTERSTITIAL MONITORING 113. CONTINUOUSATG 11T. GROUNDWATER ❑ 3. MANUAL MONITORING Cl 4. STATISTICAL INVENTORY RECONCILIATION(SIR) 1:1e. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LASTUSED(Y R/MOIDAAAYYS) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? -- D / i galone ❑Yea /No A iD1zy10 CUPAFORM(4/99) Formerly SWRCB Form 8