COMPLIANCE INFO_2003-2008 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FOR TA KS a UNDERGROUND STORAGE TANKS -TANK PAGE 1 ag e,Tank, Page _ of _ ❑ CHANGE GE OF INFORMATION) C38. TEMPORARY SITE CLOSURE y�F� TYPE OF ACTION ❑1.NEW SITE PERMIT [14. AMENDED PERMIT (3 7, PERMANENTLY CLOSED ON SIT I✓l v (Check one item only) ,�/ I�"y.RENEWAL PERMIT (Specny reason-/orfacal use only) (Specify change•PoNoca!use only) ❑ 8. TANK REMOVED 430 1 FACILITY ID k r BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) ( 43 LOCATION WITHIN SITE p�bona 9 ..� I.TANK DESCRIPTION TANK MANUFACTURER ❑ No COMPARTMENTALIZED TANK Yes TANK ID>r �� If'Yes',complete one page for each compartment. D� NUMBER OF COMPARTMENTS_ TANK CAPACITY IN GALLONS I DATE INSTALLED(Y99AR/MO) 0 00 ADDITIONAL DESP CRIT N(For local use only) � I 1 II.TANK CONTENTS f TANK USE 432 PETROLEUM TYPE ❑ 5 JET FUEL a. REGULAR UNLEADED ❑ 2. LEADED ❑ 1 MOTOR VEHICLE ❑1 FUEL a?T_pIESEL ❑ 6. AVIATION FUEL (If marked,complete Petroleum Type) ❑1D. PREMIUM UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 2. NON-FUEL PETROLEUM ❑1e MIDGRADE UNLEADED GAS K(from Hazardous Materials Inventory page) ❑ 3.CHEMICAL PRODUCT COMMON NAME(Isom Hazardous Mateha/s Inventory page) ❑ 4 HAZARDOUS WASTE(Includes Used DiQ 111.TANK CONSTRUCTION ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WAIL WITH INTERNAL BLADDER SYSTEM TYPE OF TANK ❑ 11.'SINGLE WALL EXTERIOR MEMBRANE LINER ❑99. UNKNOWN (Check one stem only) (f7 2. DOUBLE WALL ❑ 4, SINGLE WALL IN A VAULT ❑99, OTHER ❑95. UNKNOWN TANK MATERIAL•primary tank ❑ 1 BARE STEEL El 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE C3 99. OTHER - ❑ 2. STAINLESS STEEL L�7 4�. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE WI100%METHANOL (Check one item only) REINFORCED PLASTIC(FRP) ❑95. UNKNOWN ❑ 3. FIBERGLASS/PLASTIC ❑ 8. IRP COMPATIBLE W1100%METHANOL TANK MATERIAL-secondary tank ❑ 1. BARE STEEL �, . ❑99. OTHER_�- t$4. STEEL CLAD W/FIBERGLASS ❑ 9. FRP JACKET (Check one item only) ❑ 2. STAINLESS STEEL REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ 5. CONCRETE OATEINSTALLED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING C]95. UNKNOWN433 TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 6 UNLINED C199. OTHER (For Iota OR COATING ❑ 2 ALKYD LINING ❑ 4. PHENOLIC LINING DATE INSTALLED (Check one item onl) ❑95. UNKNOWN 434 OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC C33. FIBERGLASS REINFORCED PLASTIC ❑99 OTHER (Forfxa PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT (Check one item only) ❑ 2. SACRIFICIAL ANODE TYPE(For local use Only) PROTECTION EQUIPMENT.YEAR INSTALLED YEAR INSTALLED SPILL AND OVERFILL 1211. ALARM ❑ 3. Flll TUBE SHUT OFF VALVE (Check all that apply) ❑ 1. SPILL CONTAINMENT ❑ 4. EXEMPT ❑ 2. BALI FLOAT ❑ 2. DROP TUBE -- ❑ 3. STRIKER PLATE IV.TANK LEAK DETECTION - - IF DOUBLE WALL TANK OR TANK WITH BLADDER'CAeek one item only) IF SINGLE WALL TANK Check ell that a ) Cl 5 MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) . ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 8 VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 7 GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 3. CONTINUOUS ATG C3g TANK TESTING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR) ❑99 OTHER BIENNIAL TANK TESTING - V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE 14 PLACELTANK FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YRIMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING gallons ❑Yes ❑No Formerly SWRCB Fc CUPAFORM(4199)