BILLING 2006 - 2011 - Laserfiche WebLink

Home Browse Search

low UNIFIED PROGRAM CONSOLIDATED FORM TANKS Tkn)iL- ► UNDERGROUND STORAGE TANKS - TANK PAGE 1 (Two pages per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT S.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(Same as FACILITY NA ME nr DBA-Doing Business As) 3. FACILITY ID: 1 S-meET /> L0 1• M Doh-;cis 2�I[cF9M5i � � 0 � � ¢ .,., LOCATION WITHIN SITE(Optional) 431 hoo S. MAi►J S7(ZEET Mkt,1TEc.A, CA 9532,-1 I TANK DESCRIPTION (A scaled.plot plan withahe IocaHon of the USTystem.lncludi'ng buildings and landmarks shall be submitted to the local aggney.;)' . TANKID# 432. TANK MANUFACTURER 433 COMPARTMENTALIZED TANK El Yes No 434. V N L e k,OE /,EIZ)�E S If"Yes,"complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS (YEAR/MO 437. Jqcg 10-1 20,oo0 ADDITIONAL DESCRIPTION(For local use only) 438 II'TANK:CONTENTS i _ r TANK USE 439. PETROLEUM TYPE 440. 1t'l 1. MOTOR VEHICLE FUEL Kla. REGULAR UNLEADED [12. LEADED ❑5. JET FUEL (If checked,complete Petroleum Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑ 1 c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441' CAS#(from Hazardous Materials Inventory page) 442. ❑ 4. HAZARDOUS WASTE (Includes Used NO ❑ 95.UNKNOWN. b I III TANK CONSTRUCTION F. r TYPE OF TANK ❑ I. SINGLE WALL C]3. SINGLE WALL WITH EXTERIOR El 5. SINGLE WALL;;,• ..,... ,• :_- E 4,. WITH INTERNALLBLADDER SYSTEM 4<3. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primarytank ❑1. BARE STEEL X3. FIBERGLASS/PLASTIC [15. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC(FRP) W/100%METHANOL TANK MATERIAL-secondary tank ❑ 1. BARE STEEL . FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445. (Check one item only) ❑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 ❑ 1.RUBBER LINED ❑3.EPDXY LINING p 5.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING X6.UNLINED ❑99.OTHER Check one item only) OTHER CORROSION ❑ 1.MANUFACTURED CATHODIC 193.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER If Applicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION FOI gPMENT: YEAR INSTALLED 452. (Check all that apply) )9 2l.SPILL CONTAINMENT 2.004- I.ALARM 200+MS.FILL TUBE SHUTOFF VALVE 2.DROP TUBE 04 2.BALL FLOAT LO o4 ❑4.EXEMPT 3.STRIKER PLATE LV'TAN K LEAK DETECTION r (A description of the monitoring program shall bi;l,subin,ttttjd to the local agency:) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check all that apply) (Check one item only) ❑1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE 'X 2.CONTINUOUS INTERSTITIAL MONITORING [13. CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MA?s IAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN.PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 45z gallons ❑Yes ❑ No UPCF hwfwrc-b(1/99)-1/4 http://www.unidoes.org Rev.02/16/00