COMPLIANCE INFO_1996-2005 - Laserfiche WebLink

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a cF O\ \� FIED PROGRAM CONSOLIDATED FORK, a\ TA, : TA050 52 b� PR#: PR0231350 UNDERGROUND STORAGE TANKS - TANK PAGE 1 I FAC#: FA0003690 two pages per tank) Page 4 of 7 //� TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT FA5 CHANGE OF NFOR.MATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) - i• 3 } rte. ?- ❑ 7 PERM,3,NENTLY CLOSED ON SITE ;,.(Spmfyttuontorkuatttsetmty) (Specs torlonitaeoQlY) ❑ 8TANK REMOVED 430 ❑ 3 RENEWAL PERMIT BUSINESSNA:ME(SameasFACILITYNAMEorDBA-Doing Business M) FACILITY ID: PR#: I LODI FOOD&LIQUOR* ; FA0003690 PR0231350 FM I LOCATION WITHIN SITE(Optional) 1225 W LOCKEFORD ST,LODI 431 PHONE I.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#: 5 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes ❑ No 434 TA0506252 MODERN WELDING 1f"Yes',complete ompage for each comparrncnt. DATE INSTALLED(YEA=:d TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10 000 ADDITIONAL DESCRIPTION(For local use only) 433 II.TANK CONTENTS TANK USE179 PETROLEUM TYPE 440 ® I.MOTOR VEHICLE FUEL ® la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (If marked complete Pcuolcum Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 447us rdoMaterials Inventory page) 341 ❑ 4.HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN 111.TANK CONSTRUCTION TYPE OF TANK ❑ L 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 ❑ I.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check one item only) ❑ 2.STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100°'o METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE 447 TANK INTERIOR LINING ❑ I.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ®95.UXKNOW-N 446 DATE INSTALLED OR COATING ❑ 99.OTHER (Cheek one item only) ❑ 2 ALKYD LINING E] ❑4 PHENOLIC LINING 6 UNLNED (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 449 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 NSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply)PF y) SPILL CONTAINMENT 1,996.00 . - 1 ALARM 3 FILL TUBE SHUT OFF VAL' - ❑ DROPTUBE ❑ 2BALL ❑ 4EXEMPT ❑ 3 STRIKER PLATE FLOAT 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 (Check one it-only) ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) ❑ 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 M.ALNUAL MONITORING (SIR)BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE L\FOR,NIATION/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)