BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

U 0 IED PROGRAM CONSOLIDATED FORD TANKS UNDERGROUND STORAGE TANKS - TANK PAGE I (Two pag-(V Page_of TYPE OF ACTION 1.NEW PERMIT ❑ 4.AMENDED PERMIT 0 5.CHANGE OF INFORMATION [1 6.TEMPORARY TANK CLOSURE 430. (Check one item only) ❑ 3.RENEWAL PERMIT El 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3. FACILITY ID: Safeway Store#2600- 1987 West 11th Street ..... ........ LOCATION WITHIN SI"IT"(Optional) 431 NE comer of West 11th Street and Corral Hollow Road 1. TANK DESCRIPTION (ANcated.plotplam.vm4th.he,locatioiiol'theUS'I'system including buildings and landmarks shall be,wbinitted to the local agency.) TANK ID 0 432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK Z Yes [I No 434. x3 Modern Welding Co. Inc. If"Yes,"complete one page for each compartment. DATE INSTALLED 435, TANK CAPACITY IN GALLONS 436- NUMBER OF COMPARTMENTS 437. (YEAR/MO) 2002,March --2", N C) 2 ADDITIONAL DESCRIPTION(For local we only) 438. 11. TANK CONTENTS TANK USE 439. 440. 0 1 MOTOR VEHICLE FUEL El Ia. REGULAR UNLEADED 0 2. LEADED El 5. JET FUEL (If checked,complete Petroleum Type) -Oft. PREMIUM UNLEADED 0 3. DIESEL [16. AVIATION GAS 0 2. NON-FURL PETROLEUM 0 lc. MIDGRADE UNLEADED 0 4. GASOHOL 0 99.OTHER: - 0 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441. CAS#(from Hazardous Materials Inventory page) 442. [] 4. HAZARDOUS WASTE PREMIUM UNLEADED 8006-61-9 (includes Used Oil) MIDGRADE UNLEADED 0 95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK El I. SINGLE WALL 0 3. SINGLE WALL WITH EXTERIOR 05, SINGLE WALL WITH IN-IERNAL BLADDER SYSTI;m 443 (Check one item only) MEMBRANE LINER El 95. UNKNOWN 0 2, DOUBLE WALL 04. SINGLE WALL IN A VAULT El 99. OTHER TANK MATERIAL-primary tank 0 1. BARE STEEL U 3. FIBERGLASS/PLASTIC U 5. CONCRETE D 95.UNKNOWN 444. (Check one item only) D 2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS 0 8. FRP COMPATIBLE El 99.OTHER: REINFORCED PLASTICKrRP) W/100%1�ETHANOL TANK MATERIAL-secondary tank []1. BARE STEEL DQ 3. FIBERGLASS/PLASTIC 8. FRP COMPTIBLE W/100%METHANOL 95.UNKNOWN 445. (Check one item only) D 2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING 0 1.RUBBER LINED D 3.EPDXY LINING 0 5.GLASS LINING- 95.UNKNOWN446. DATE INSTALLED 447. OR COATING 0 2.ALKYD LINING 0 4.PHENOLIC LINING 0 6.UNLINED 0 99.OTHER (Check one item onlyL OTHER CORROSION ❑1.MANUFACTURED CATHODIC 0 3.FIBERGLASS REINFORCED PLASTIC U95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION 0 4.IMPRESSED CURRENT 0 99.OTHER (If Applicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) 1.SPILL CONTAINMENT _2001_ Phil-Tite85000 0 I.ALARM D 3.FILL TUBE SHUT OFF VALVE 2.DROP TUBE 2001 OPW 61T-7368 ED 2.BALL FLOAT ❑4.EXEMPT 3.STRIKER PLATE Tank Mfg Modem Welding IV. TANK LEAK DETECTION .(A description of monitoring pt2gr4!ti,Shall be submitted to the local.llgotiq-) IFSINGLE WALLTANK 453. IF DOUBLE WALLTANK OR TANK WITH 13LADDER 454. (Check all that apply) (Check one item only) El 1. VISUAL(EXPOSED PORTION ONLY) D 5.MANUAL TANK GAUGING(1%4TG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) 0 6.VADOSE ZONE 2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG []7.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.M TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRIMO/DAy) 455m ESTIMATED QUANTITY OF SUBSTANCE REMAINING NK FILLED WITH INERT MATERIAL? gallons C1 Y. 0 No /V P/ UPCF hwfwrc-b(1/99)-1/4 littp://ivww.unidocs.org 01 Rev.02/16/00