COMPLIANCE INFO_FILE 12 - Laserfiche WebLink

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3 NIFIED PROGRAM CONSOLIDATED FORIP- 0 1[j) TANK: TA0505217 PR#: PR0231945 UNDERGROUND STORAGE TANKS -TANK PAGE 1 FAC#: FA0003934 (two pages per tank) TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMITPage 10 of I 1 ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check only item only) Ps 8 11 !tl h r ¢ q^I P ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 BUSINESS NAME(same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: I LLNL-SITE 300* 3 FA0003934 PR0231945 LOCATION WITHIN SITE(optional) CORRAL HOLLOW RD,TRACY 431 BLDG 871-D1U2(34) PHONE 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# Tank#: 34 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ❑No 434 TA0505217 MODERN WELDING CO INC ,f"Yea°°,complete one page for each carpartttent. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 9/1/1994 12:00:00AM 1,000 ADDITIONAL DESCRIPTION(For local use only) 438 CHNG PE FR 2315 PER SS IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1.MOTOR VEHICLE FUEL ❑ 1 a.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (I£markedconplete Petroleum Type) ❑ lb.PREMIUM UNLEADED ® 3.DIESEL E] 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ I c.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazard.Materials immtory page) 442 ❑4.HAZARDOUS WASTE (Includes Used Oil) 68334-30-5 ❑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 itcmonly) 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 ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING 447 OR COATING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED (Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99.OTHER (For local use only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC 449 PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC E] 95 UNKNOWN 448 DATE INSTALLED (Check one item only) ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) ® 1 SPILL CONTAINMENT 1,994.00 ® I ALARM 1,994.00 ® 3 FILL TUBE SHUT OFF VAL` 1,994.00 ❑X 2 DROP TUBE 1,994.00 ® 2 BALL 1,994.00 ❑ 4 EXEMPT ❑X 3 STRIKER PLATE 1,994.00 FLOAT IV.TANK LEAK DETECTION(A description o£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 ❑ 1 VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one it-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) ass ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑ No UPCF(12/99 revised)