COMPLIANCE INFO_1998-2006 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 0 I (two pages per tank) f Page _ of TYPE OF ACTION �1.NEW SITE PERMIT 1-14.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 8. TEMPORARY SITE CLOSURE (Check one item only) !! C1❑3.RENEWAL PERMIT 7. PERMANENTLY CLOSED ON SITE (Specify reason-for local use only) (Specify change-for local use only) ❑ 8. TANK REMOVED 430 BUSINESS NAME(Same as rFACILITY NAME or OBA-Doing Business As) FACILITY ID a 1 LOCATION WITHIN SITE(Opb'onaQ 431� * r 1.TANK DESCRIPTION TANK 10 a A TANK MANUFACTURER / V ! / COMPARTMENTALIZED TANK ❑ Yes en /�(` I!'Yes',complete one page for each compartment. TE INSTALLED(YEAR/MO) TANK CAPACITY IN CALLONS NUMBER OF COMPARTMENTS 02-/- q, ? ADDITIONAL DESCRIPTION(Forlocal use only) II.TANK CONTENTS TANK USE 432PETROLEUM TYPE 1 1. MOTOR VEHICLE FUEL 'a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If rked,complete Petroleum Type) ❑1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑1c MIDGRAOE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3. CHEMICALPRODUCT C1 4. HAZARDOUS WASTE/Includes COMMON NAME(from Hazardous Materials Inventory page) CAS a(from Hazardous Materials Inventory page) Used DO 95 UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK �❑l 1. SINGLE WALL ❑ 3. SINGLE WALL WITH El S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item only) yJ 2, DOUBLE WALL EXTERIOR MEMBRANE LINER 1195. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL.primary tank ❑ 1 BARE STEEL I. FIBERGLASS/PLASTIC ��`❑ 5. CONCRETE El 95. UNKNOWN (Check one item only) C12, STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS R B. FRP COMPATIBLE W/1 CC%METHANOL C199. OTHER REINFORCED PLASTIC(FRP) ' \ TANK MATERIAL-secondary tank ❑ 1 BARE STEEL 3. FIBERGLASS/PLASTIC J8. FRP COMPATIBLE W1100%METHANOL ❑95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS /❑ 9. FRP NON-CORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1_ RUBBER LINED C1 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 DATE INSTALLED OR COATING _ - ❑ 2. ALKYO LINING ❑ 4. PHENOLIC LINING 8. UNLINED 99. OTHER (Check one item on ) (For local use only) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC 113. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION 4. IMPRESSED CURRENT 1199, OTHER 111 (Check one item only) ❑ 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL - YEAR INSTALLED TYPE(For local use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check all that apply) ❑ 1. SPILL CONTAINMENT n ❑ 1. ALARM >64 FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE !?I? ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE vgr IV. TANK LEAK DETECTION IF SINGLE WALL TANK(Check all that apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one dem only): ❑ 1, VISUAL(EXPOSED PORTION ONLY) 1 ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VAOOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)* ❑ S. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED WITH INERT MATERIAL? 14 gallons ❑Yes ❑No F4000 3q-rg CUPAFORM(4/99) is Formerly SWRCB Form B I