BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

VIFIED PROGRAM CONSOLIDATED FORA / / 'STANK: TA0122304 �/r'j D/ PR#: PR0231223 OC - 1 2007 UNDERGROUND STORAGE TANKS - TANK A 1 FAC N: FA0002324 It U o (t=o pages per tank) TYP MEW HEALTH i�[ Page 2of7 (Check onl>,'�tWiT/l�}�J11>�E PERMIT ❑ 4 AMENDED PERMIT �J 5 CHANGE OF INFORMATION ❑6 TEMPORARY SITE CLOSURE J C f,J ' v ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Speeif,reason-for total use only) ❑8 TANK REMOVED 4311 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: 1 MARIGOLD SHELL* 3 FA0002324 PR0231223 LOCATION WITHIN SITE(optional) 6131 PACIFIC AVE,STOCKTON 431 PHONE 1.TANK DESCRIPTION(A scaled plot plan NN ith the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# Tank#: 4 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes [:]No 434 TA0122304 OWENS CORNING If"Yes",complete oec page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 12,000 ADDITIONAL DESCRIPTION(For local use only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ® I a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmarkedcomplete Petroleum Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑6.AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME from H.,ardo ni Materials Inventory 2 ( page) 441 CAS#(from Hmardous Materials Inventory page) 44 ❑ 4.HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN M.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ®2.DOUBLE WALL ❑ 4 SINGLE WALL IN VAULT ❑99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑5.CONCRETE ❑95.UNKNOWN 444 (Check one item only) ❑2.STAINLESS STEEL ® STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑99.OTHER TANK MATERIAL-secondary tank ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑5.CONCRETE ❑95.UNKNOWN 445 (Chock one item only) ❑ 2.STAINLESS STEEL ®4.STEEL CLAD W/FIBERGLASS ❑8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check one item only) ❑2 ALKYD LINING ❑4 PHENOLIC LINING ®6 UNLINED ❑99.OTHER (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check one item only ❑ 41MPPESSED CURRENT ❑99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ® I SPILL CONTAINMENT -+qwg Z coq lop V J ® I ALARM 1,990.00 %3 FILL TUBE SHUT OFF VAL` .21)0S x❑ 2 DROP TUBE 1,990.00 ❑ 2 BALL ❑4 EXEMPT ❑X 3 STRIKER PLATE 1,990.00 FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)