COMPLIANCE INFO_2005-2012 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (Two pages Per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check me item only) 3.RENEWAL PERMIT A t6 4 .PI 7 b e4 2V^ /otN3 ❑ 7-PERMANENTLY CLOSED ON SITE (specify Rawo) (Spad'y rm ) ❑ 8.TANK REMOVED B INESSNAME(SamcasFACRMNAMEorDBA-DoingBuvnessAs) s. FACILITY ID: 1. ` C U r-- fi A t� n C. 3 8 LOMTION WTTFIIN SITE(opdomt) 431. ISO �bc ce- t- -T CrA CC., 9 S 31 jo L TAINK 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#(� r Ql SFO/,,v v TANK MANUFA433. COMPARTMENTALIZED TANK [I Yes El No a34. MnAQ l/�CTURER rt 5 If"Yes 7 complete one page foreach camparkmmt DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 (YEAR/MO)�A now M 6 O,v ADDITIONAL DESCRIPTION(For tical use owy) 1 438. IL TANK CONTENTS TANK USE 439. PETROLEUM TYPE 440. X 1.MOTOR VEHICLE FUEL la. REGULAR UNLEADED ❑2- LEADED ❑5. JET FUEL (If checked.-pleve petrokom Type) ❑lb. PREMIUM UNLEADED ❑3.DIESEL ❑6. AVIATION GAS ❑ 2.NON-FUEL PETROLEUM ❑Ic.MIDG,RADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑ 3. CH EWCAL PRODUCT' COMMON NAME (from H--d-s mwaiats hr. gory page) 441. CAS#(from Hamad.Mueriats inventory page> 442. ❑ 4. HAZARDOUS WASTE (Tneludes Used Oil) �T ❑ 95.UNKNOWN , �il Jz- IIL TANK CONSTRUCTION TYPE OF TANK ❑1.SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) MEMBRANE LINER ❑95. UNKNOWN 2.DOUBLE WALL [14. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-pommy tank -1. BARE STEEL 3.FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 444. om (Check me item only) [12. STAINLESS STEEL 4. STEEL CLAD W/FIBERGLASS ❑8.FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC W/1 W%METHANOL TANK MATERIAL-secondary tank El l. BARE STEEL 3. FIBERGLASS/PLASTIC [18-FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL.❑4. STEEL CLAD W/FIBERGLASS [19.FRP NON-CORRODABLE JACKET [199-OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING El 1.RUBBER LINED ❑3.EPDXY LINING 5.GLASS LINING 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING 6.UNLINED ❑99.OTHER Check one item only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC ❑3.FIBERGLASS REINFORCED PLASTIC D95-UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT [199.OTHER (IfApplicablej_ ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) 'K1.SPILL CONTAINMENT 'N T1 F- V 9 El1.ALARM 3.FILL TUBE SHUT OFF VALVE Q-S r 2.DROP TUBE YN C v R ❑2.BALL FLOAT 4.EXEMPT (�3.STRIKER PLATE S Te c IV.TANK LEAK DETECTION (A description ofthe monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. ((beck all that apply) (Check one item only) ❑1.VISUAL TXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE A2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG ❑7.GROUNDWATER [13-MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (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 056' TANK FILLED WTI$INERT MATERIAL? 453. gellons ❑Yes ❑ No