COMPLIANCE INFO_2003-2008 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FOR l T--oAN UNDERGROUND STORAGE TANKS TANK PAGE i (two page sp r ariX) Page + ❑ 5.CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE 'J ❑7.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 7. PERMANENTLY CLOSED ON SIT TYPE OF ACTION 430 (Check one item only) ��' (Specify change.for local use only) ❑ 8. TANK REMOVED LrJ 3.RENEWAL PERMIT (gpaci/y reason•lorlxal use oNy) 1 FACILITY ID 11 / BUSINESS NAME(Same as FACILITY NAME or DBA•Doing Business As) L pv�c FIc LOCATION WITHIN SITE(Option431aq -y( 1.TANK DESCRIPTION Yes ❑ No J TANK MANUFACTURER COMPARTMENTALIZED TANK It'Yes',complete one page for each compartment. TANK ID II 5a - �7-C4r G�S C G NUMBER OFC MP TMENTS TANK CAPACITY IN GALLONS DATE INSTALLED(YEARIMO) (5 00 Rq ADDITIONAL DESC IPTION(Forlocal use only) II.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 2 LEADED ❑ 5. JET FUEL MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑ 6. AVIATION FUEL �1 ❑ 3. DIESEL (I/marked.complete petroleum Type) &TS' PREMIUM UNLEADED ❑99. OTHER ❑ 4. GASOHOL ❑ 2. NON-FUEL PETROLEUM ❑1c MIDGRADE UNLEADED CAS w(from Hazardous Materials Inventory page) ❑ 3. CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) ❑ 4 HAZARDOUS WASTE(Includes Used 0,0 111.TANK CONSTRUCTION C]❑ 3. SINGLE WALL W17H 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM TYPE OF TANK o❑ 1. SINGLE WALL. EXTERIOR MEMBRANE LINER ❑95. UNKNOWN (Check one item only) C 2. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT ❑99 OTHER ❑95. UNKNOWN C1LA TANK MATERIAL•primary tank C] 1 ggRE STEEL 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE S-- �/ ❑99. OTHER Ip a. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE Wlloo a METHANOL (Check one item only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑95, UNKNOWN TANK MATERIAL.secondary tank ❑ 1, ❑ 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE Wil E J METHANOL ❑99 OTHER�-- BARE STEEL W�STEEI CIAO W/FIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET I (Check one item only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ 5. CONCRETE DATE INSTALLED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 TANK INTERIOR LINING C] 1. RUBBER LINED ❑ 6 UNLINED ❑99. OTHER (For ❑ 2. ALKYD LINING loca OR COATING C] 4. PHENOLIC LINING DATE INSTALLED 434 (Check one item onl) ❑95. UNKNOWN OTHER CORROSION ❑ I. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑99 OTHER�--- (For local PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT (Check one item only) ❑ 2. SACRIFICIAL ANODE at use onty)TYPE(ForlocOVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED P 9,e?I �1.ALARM 3. YEAR INSTALLED t SPILL AND OVERFILL ❑ FILL TUBE SHUT OFF VALVE (Check all 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 only), IF SINGLE WALL TANK Check all that a ): ❑ 5. MANUAL TANK GAUGING(MTC) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) . ❑ 1, VISUAL(EXPOSED PORTION ONLY) 2<2 CONTINUOUS INTERSTITIAL MONITORING ❑ 6. VADOSE 20NE ❑ 3 MANUAL MONITORING ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 7. GROUNDWATER ❑ 3. CONTINUOUS ATG ❑ g. TANK TESTING [34. STATISTICAL INVENTORY RECONCILIATION(SIR) BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE 14 LACE35 K FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YRlMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING gallons ❑Yes ❑Na Formerly SVVRCB F0 CUPAFORM(4/99)