COMPLIANCE INFO_1999-2010 - Laserfiche WebLink

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i IFIEDPROGRAM CONSOLIDATE ORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page _ of _ TYPE OF ACTION Fl. NEW SITE PERMIT F 4. AMENDED PERMIT CHANGE OF INFORMATION) F 6. TEMPORARY SITE CLOSURE (Check one item only) F 7. PERMANENTLY CLOSED ON SITE F3. RENEWALPERMIT (Specify reason-for local use only) (Specify change-for local use only) F 8. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID d€ 1:. I I I ITT I . ... ro ; LOCAT-ION WITHIN SITE(Optional) 431 1.TANK ESERIPTION< A'sGaled plot plan with the locatioicofthe UST system 006ding bui%dings'and landmarks shag be submitted,to.theldcaF agency) TANK ID# _. __ /. 432.. TANK MANUFACTURER ._...._. 433 _....... _ _..... COMPARTMENTALIZED TANK F Yes No 434 1 -- - � (�`V^ tf AYes=,complete one page for each com arlment. DATE INSTALLED(YEAR/MO) / -J-• 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1.57 ADDITIONAL DESCRIPTION(Forlocal use only) 438 r ::' II,TANK .CAIVTNTS� u ...:, TANK USE 439 _ !/ PETROLEUM TYPE 440 MOTOR VEHICLE FUEL f eta REGULAR UNLEADED F 2. LEADED F 5. JET FUEL (,/marked,complete Petroleum Type) r,1bb, PREMIUM UNLEADED 1-3. DIESEL IF 6. AVIATION FUEL r 2. NON-FUEL PETROLEUM F 10, MIDGRADE UNLEADED F 4. GASOHOL r 99. OTHER r 3. CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 r 4. HAZARDOUS WASTE(Includes Used Oil) r95. UNKNOWN III:;fANIC,CONS7Rl'1C' OOM,,. TYPE OF TANK 1. SINGLE WALL r 3. SINGLE WALL WITH r 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) p�2. DOUBLE WALL EXTERIOR MEMBRANE LINER r 95. UNKNOWN l F 4. SINGLE WALL IN A VAULT F 99. OTHER TANK MATERIAL-primary tank F 1. BARE STEEL 7-4 FIBERGLASS/PLASTIC F S. CONCRETE 1['95. UNKNOWN 444 (Check one item only) F 2. STAINLESS STEEL F 4. STEEL CLAD WFIBERGLASS F 8. FRP COMPATIBLE W100%METHANOL F 99. OTHER REINFORCED PLASTIC F TANK MATERIAL-secondary ] 1. BARE STEEL FIBERGLASS/PLASTIC F 8. FRP COMPATIBLE W100%METHANOL r95. UNKNOWN 445 tank F 2. STAINLESS STEEL r 4. STEEL CLAD F 9. FRP NON-CORRODIBLE JACKET F 99. OTHER (Check one item only) WFIBERGLASS REINFORCED PLASTIC r 10. COATED STEEL (FRP) F 5. CONCRETE TANK INTERIOR LININGF 1. RUBBER LINED r 3. EPDXY LINING r GLASS LINING F 95. UNKNOM446 DATE INSTALLED 447 OR COATING F 2. ALKYD LINING r 4. PHENOLIC LINING UNLINED r99. OTHER (Check one item only) For local use only) OTHER CORROSION F 1. MANUFACTURED r 3. FIBERGLASS REINFORCED PLASTIC F 95. UNKNOWN 448 DATE INSTALLED PROTECTIONION IF IF APPLICABLE 449 CATHODIC r4. IMPRESSED CURRENT r99. OTHER (Check one item only) PROTECTION F 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only)451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 4+50 (� 1 (Check all that apply) r 1. SPILL CONTAINMENT t 11. ALARM �3. FILL TUBE SHUT OFF VALVE l r 2. DROP TUBE I .S=` F 2. BALL FLOAT r 4. EXEMPT F 3. STRIKER PLATE („Q_ w« Q.;'� V...?. a ` t � 1�,'jTAN AI C TF 4A,q tr e$ddp#orroltherbnrtorrngpta�gramst+all;l�eysubmitfpd,t¢.the IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 F 1, VISUAL(EXPOSED PORTION ONLY) F 5. MANUAL TANK GAUGING(MTG) F 1. VISUAL(SINGLE WALL IN VAULT ONLY) F 2. AUTOMATIC TANK GAUGING(ATG) F 6. VADOSE ZONE F 2. CONTINUOUS INTERSTITIAL MONITORING F 3. CONTINUOUS ATG F 7. GROUNDWATER r 3. MANUAL MONITORING F 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ F 8. TANK TESTING o IC.M[AI.TARO!TFCTIAIR _ FAWN CLOSUR ,INFOFtM710N1 PERMANENT C'G OSURE.IN PI ACE•; ESTIMATED DATE LAST USED(YR/MO/DAY) 455 MATED QUANTITYO F SUBSTANCE REMAINING TANK FILLED WITH INERT MATERIAL? 457 gallons F Yes FN.