COMPLIANCE INFO_1999-2009 - Laserfiche WebLink

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IFIED PROGRAM CONSOLIDATED FORMO TANK. TA0507804 PR #: PR0231342 UNDERGROUND STORAGE TANKS - TANK PAGE 11� FAC #: FA0000392 (two pages per tank) TYPE OF ACTION Page 6 of 7 ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) ` ^ ''" �f 5"'`°^t ❑ 7 PERMANENTLY CLOSED ON SITE )' ❑ 3 RENEWAL PERMIT rt x ` s,' k r ❑ 8 TANK REMOVED 430 BUSINESS NAME (Same as FACB.rrY NAME or DBA - Doing Business As) FACILITY ID: PR #: I FLAME LIQUOR & GAS 3 FA0000392 PR0231342 LOCATION WITHIN SITE (optional) 1301 W KETTLEMAN LN, LODI 431 PHONE 1. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# Tank #: 6 432 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK ❑ yes ❑ No 434 TA0507804 TRUSCO If "Yes", complete one page for each compartmem. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3/1/1998 12:00:OOAM 10,000 ADDITIONAL DESCRIPTION (For local me only) 438 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® L MOTOR VEHICLE FUEL ❑ I a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If marked complete Pctroleum Type) J J� lb. PREMIUM UNLEADED � �3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM �❑ ) o. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAMEfrom Hazardous Materials invent ( inventory erase) 441 CAS# from Hazardoiu Materials ( inventory Page) aaz ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95. UNKNOWN IH. TANK CONSTRUCTION TYPE OF TANK ❑ 1. 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 ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 445 (Check one item only) ❑ 2. STAINLESS STEEL ' V4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/100% METHANOL EINFORCED 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 ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER (Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED '),,,, za/ 452 1 SPILL CONTAINMENT (Check all that apply) �� ❑ 1 ALARM I l► 3 FILL TUBE SHUT OFF VALE 'C❑4 I 2 DROP TUBE � ,.L..J I , 2 BALL EXEMPT 3 STRIKER PLATE OAT 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 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑ Yes ❑ No UPCF (12/99 revised)