COMPLIANCE INFO_FILE 12 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM-TANKS I UDij4)%-j1q1P .� t UNDERGROUND STORAGE TANKS-TANK PAGE 1 ti M,G31,1,WGAIG05115 Two pages per tank Page 1 of 2 TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430 (Chea one item Only) ❑ 3 RENEWAL PERMIT __.-._.._._._._......_....--_._.-- -------------_---------_--------- ❑ 7.PERMANENTLY CLOSED ONSITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSTNESSNAME(SameasFAGUTYNAMEo•DDA-Doing Business As) 3, 1 FACILITY ID: 1 I Lawrence Livermore National Laboratory-Site 300 T1 I I I I LOCATION WITHIN SITE(optional) 431. Building 879-South side 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# 879-G31-11 432, TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 390002319450505184 TRUSCO If Yes,complete one page for each compartment DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437. 1994/06 15,000 1 ADDITIONAL DESCRIPTION(For local useomy) 438 II.TANK CONTENTS TANK USE 439, PETROLEUM TYPE 440. ® 1. MOTOR VEHICLE FUEL 0 Ia. REGULAR UNLEADED ❑2. LEADED ❑5 JET FUEL (If checked.complete Petroleum Type) ❑ib. PREMIUM UNLEADED ❑3. DIESEL 0 AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑To. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441. CAS#(from Hazardous Materials Inventory page) 442. ❑ 4. HAZARDOUS WASTE Unleaded Gasoline 8006-61-9 (Includes Used Oil) ❑ 95.UNKNOWN III.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 ❑4. SINGLE WALL IN A VAULT ❑99. OTHER _ TANK MATERIAL-primary tam 0 1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2, STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: _ REINFORCED PLASTIC FRP W1100916 METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS 1 PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ®4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) [110, COATED STEEL ❑5. CONCRETE _ TANK INTERIOR LINING [31.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 ilern only) OTHER CORROSION ❑1.MANUFACTURED CATHODIC - ❑3.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DAI E 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) ®1.SPILL CONTAINMENT 2005 0 1 ALARM 1994 0 3.FILL TUBE SHUT OFf VALVE 2005 ®2.DROP TUBE 2005 ❑2 BALL FLOAT ❑4.EXEMPT N 3.STRIKER PLATE 19N IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to 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) ❑1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE 0 2.CONTINUOUS INTERSTITIAL MONITORING ❑3. CONI INUOUSAIG ❑7.GROUNDWATER ❑3 MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR).BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 465 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL.? 457. NA _____.-.________.--- ___gallons ❑Yes ❑ No [IPCF hwAvrc-b(1/99)-1/4 htip://www.unidocs.org Rev.02/16/00