BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

VIONIFIED PROGRAM CONSOLIDATED F UNDERGROUND STORAGE TANK C> (Lt(3 OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections 1,11,III,IV,and IX below) 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ] 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4306 DATE EXISTING UST DISCOVERED: 430b L FACILITY INFORMATION FACI I,ITY ID#(Agency Use Only) I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Safeway Fuel Station 2600-10 BUSINESS SITE ADDRESS 103 CITY 104 1987 West 1 1 th Street Tracy II.TANK DESCRIPTION TANK ID#_2- 432 TANK MAN[1F'ACTURER 4i; T.ANKCONFIGURATIO\: THISTANKIS 434 12,4Modern Welding ❑ 1.A STAND-ALONE TANK ®2.ONE IN A COMPARTMENTED UNIT. Complete one page for each compartment in the unit. DATE USf SYSTEM INSTALLE11 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 9/2002 10,000 2 III.TANK USE AND CONTENTS TANK USE E In.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[H5C§2i281 S(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ Ib.PREMIUM UNLEADED 440 1-2 DI_F�FI. ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLFUM(Specify): 4406 IV. TANK CONSTRUCTION TYPE OF"TANK ❑ 1.SINGLE WALL E 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® I.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS E 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4 TANK MEETS RFQUIRF.MFNTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I.SINGLE-WALLED E 2.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ® 1.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR p2636(a)(3)) 458 PRIMARY CONTAINMENT ❑ I.STEEL ❑ 4.FIBERGLASS E 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NON ❑ 95.UNKNOWN ❑ 99.OTHER(Specifv): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE E L SINGLE WALL ❑ 2.DOUBLE WAIL. ❑ 90.NONE 464d VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1.STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC E 90.NONE ❑ 99.OTHER(Specify) 464E 464n VR PRIMARY CONTAINMENT ❑ I.STEEL E 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464s 464g I VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10,RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90.NONE 464i RISER PRIMARY CONTAINMENT ® I.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NOME ❑ 99.OTHER(Specify) 464j 464'I RISER SECONDARY CONTAINMENT ❑ I.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 46641 FILL COMPONENTS INSTALLED ® 1.SPILT.BUCKET E 3 STRIKER PLATE/BOTTOM PROTECTOR E 4.CONTAINMENT SUMP 45la-c Vil. UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE E 1,SINGLE WALT. ❑ 2.DOUBLE WALL ❑ 3 NO DISPENSERS ❑ 90.NONE 11 469a CONSTRUCTION MAIFRIAL El STEEL E 4 f113ERGLASS ❑ IQRIGIDPLASTIC El99.OTHER(Specify) `'a 469b-c VIII. CORROSION PROTECTION STEEL.COMPONFNT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448 IX. APPLICANT SIGNATURE CER'T'IFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided hereins.y ,accurate, and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 4/15/2010 470 APPLICANT NAME(print) Butch Hobson 471 APPLICANT TITLE Safety and Environmental Affairs Mgr 472 UPCF UST-B- 1/2 Rev.(12/2007)