COMPLIANCE INFO_2003-2008 - Laserfiche WebLink

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V _D PROGRAM CONSOLIDATED FORe. TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 ( ae,7ank) Page _ of _ ❑ S.CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE ❑ 7. PERMANENTLY CLOSED ON SITE TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT C. (Check one item only) B.TANK REMOVED 430 RENEWAL PERMIT (Spec)fy (Specify change•lorlocal use on)y) reason•/oNocal use onlYl FACILITY 10 N _K5 USINESS NAME(Same as FACILITY NAME or DBA•Doing Business As) ,gc -Fic Nif,c// MA�-T ✓0 3 ,� 43 LOCATION W17HIN SITE ptlonan I.TANK DESCRIPTION Q Yes ❑ No TANK MANUFACTURER COMPARTMENTALIZED TANK If-yes',complete one page for each compartment. TANK IDN /OT&�� D� NUMBER OF COM��'PAyyyRT...MENT TANK CAPACITY IN GALLONS 1 DATE INSTALLED(YEAR/MO) �•D�� /`? 9 ADOITIONAL DESCRIPT N(Forlocal use only) IL TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 2 LEADED ❑ 5 JET FUEL ' I ❑ 1 MOTOR VEHICLE FUEL ❑Is REGULAR UNLEADED [P-5-DIESEL ❑ 6. AVIATION FUEL (If marked,complete Petroleum Type) ❑to_ PREMIUM UNLEADED ❑99. OTHER ❑ 4. GASOHOL I ❑ 2. NON-FUEL PETROLEUM ❑tc MIOGRADE UNLEADED CAS N(from Hazardous Materials Inventorypage) ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) ❑ p HAZARDOUS WASTE(Includes Used Orn III.TANK CONSTRUCTION ❑ 5. SINGLE WALL HATH INTERNAL BLADDER SYSTEM TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALLWITH ❑95. UNKNOWN EXTERIOR MEMBRANE LINER (Check one item only) 0-2. DOUBLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑99, OTHER TANK MATERIAL.primary tank ❑ 1 BARE STEEL ❑ 5. CONCRETE ❑95. UNKNOWN ❑ 3. FIBERGLASS/PLASTIC/'• �� ,., ❑ 2, STAINLESS STEEL LTJ 4. STEEL CLAD W/FIBERGLASS ❑ B FRP COMPATIBLE W1100y METHANOL ❑99. OTHER (Check one dem only) REINFORCED PLASTIC(FRF) ❑ 3. FIBERGLASS/PLASTIC ❑ B. FRP COMPATIBLE W/100°A METHANOL ❑95. UNKNOWN TANK MATERIAL.secondary tank ❑ 1. BARE STEEL ��/ ❑99. OTHER�� La 4. STEEL CUD W/FIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET (Check one item only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ 5. CONCRETE. EPDXY LINING DATEINSTALLED ❑ 3 ❑ 5. GLASS LINING ❑95. UNKNOWN433 TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 6 UNLINED ❑99. OTHER (For Iota C1 2. ALKYD LINING OR COATING ❑ 4. PHENOLIC LINING DATE INSTALLED 434 (Check one item onl) ❑95. UNKNOWN OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑99 OTHER (Porloca PROTECTION IF APPLICABLE PROTECTION ❑ A. IMPRESSED CURRENT (Check one item onty) ❑ 2. SACRIFICIAL ANODE TYPE(For Kcal use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED YEAR INSTALLED SPILL AND OVERFILL OW"1. ALARM ❑ 3. FILL 7UBE SHUT OFF VALVE tl (Check am that apply) ❑ 1 SPILL CONTAINMENT_ ❑ 2 BALL FLOAT ❑ 4. EXEMPT ❑ 2. DROP TUBE ❑ 3. STRIKER PLATE N.TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER'Check one item onl 1 IF SINGLE WALL TANK Check ell that a ) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 5. MANUAL TANK GAUGING(MTC) ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 6 VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 7 GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 3. CONTINUOUS ATG ❑ S. TANKTESTING C34. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑99 OTHER BIENNIAL TANK TESTING V.TANK CLOSURE INFORMATION(PERMANENT CLOSURE 14F� AC5TANK FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING gallons ❑Yes ❑No Formerly SWRCB F` CUPAFORM(4199)