COMPLIANCE INFO_2005-2008 - Laserfiche WebLink

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V\ UI&ED PR GRAM CONSOLIDATED F01 b I TANKS d *0 tip(t,9 UNDERGROUND STORAGE TANKS - TANK PAGE 1 Y { (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 one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED FACILITY ID: BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3. LOCATI WIT IN SITE( ptional) 431. ?t'- eve (,4 R(�326 " TANK DESCRIPTION (A scaled;plot glattloifi tlie-locatto>J of thg t T system inclW ng buildings and lattc7m�rks shall be submitted to the local agency:) TANK ID#7-t9 �>432. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK ❑Yes No 434. �qf',t}• If"Yes,"complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 (YEAR/MO)D i/©1 J iV-6 ADDITIONAL DESCRIPTION(For local use only) 438. GONTEM S4 E TANK USE 439" PETROLEUM TYPE 440. ❑ 1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (If checked,complete Petroleum Type) ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS ❑ 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. fii 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN I3I:TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [13. , SINGLE WALL WITH EXTERIOR ❑3. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443_ (Check one item only) MEMBRANE LINER ❑95. UNKNOWN 2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tank 1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) [12. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTICFRP W/100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC [18. FRP COMPTIBLE W/100%METHANOL [195.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑I.RUBBER LINED [13.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING [16.UNLINED ❑99.OTHER (Check one item only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC [13.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER (If Applicable) 2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) w 1.SPILL CONTAINMENT ❑L ALARM [13.FILL TUBE SHUT OFF VALVE 4!72.DROP TUBE [12.BALL FLOAT [14.EXEMPT 9.STRIKER PLATE (A'descripti6n of the"monitoring.program shall be subrti#tO4to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) [11. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ❑2.CONTINUOUS INTERSTITIAL MONITORING [13.CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V."TANK a0SU14k INFORMATION/ PERMANENT CLOSURE IN PLACE TANK FILLED WITH[VERT MATERIAL? 457. ESTIMATED DATE LAST USED(YR/MO/DAY) 455' ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456' gallons [I Yes ❑ No UPCF hwfwrc-b(1/99)-1/4 hUp://www.unidocs.org Rev.02/16/00