COMPLIANCE INFO_1999-2005 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM 3\' � o� TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 a (two pages per tank) T TYPE OF AC'T'ION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANCE OF INFORMATION El TEMPORARY SITE CLOSURE Page of (Check one item only) -- _ ___ _ ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use onl y) ❑ 8 TANK REMOVED 430 13IJSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: ETT7 USA GASOLINE#3 51 3 3 / 03 LOCATION WITHIN SITE(Optional) 431 L 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# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK []Yes ® No 434 TRUSCO If"Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY [N GALLONS 43T NUMBER OF COMPARTMENTS 437 1998 14000 ADDITIONAL DESCRIPTION(For local use only) nix II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® 1 MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL nno (If marked complete Petroleum Type) ®1b. PREMIUM UNLEADED ❑3. DIESEL [16. AVIATION FUEL ❑2 NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 [:14. HAZARDOUS WASTE (Includes Used Oil) ❑95.UNKNOWN III. 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 [14. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank D9 1. BARE STEEL 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95 UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS 118. FRYCOMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank ❑1. BARE STEEL 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 44S (Check one item only) ❑2. STAINLESS STEEL ®4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOI. ❑99 OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING 0 L RUBBER LINED U 3.EPDXY LINING S.GLASS LINING U 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING (Check one item only) ®6 UNLINED ❑99 OTHER (For local use only) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC 1195 UNKNOWN 44x 448 PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ®1 SPILL CONTAINMENT 1998 ❑ I ALARM ®3 FILL TUBE SHUT'OFF VALVE ®2 DROP TUBE 1998 ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 1998 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 El VISUAL(EXPOSED PORTION ONLY (Check one item only) ) ❑5 MANUAL TANK GAUGING(MTG) ❑I VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.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 gallons ❑Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B