COMPLIANCE INFO_1989-2008 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 11 (two pages per tank) rage _ or _ TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check one item only) ❑ 7. PERMANENTLY CLOSED ON SITE V3, RENEWAL PERMIT (Soecly mason - forkrca/ use only) (Spsciy change - for local use only) ❑ S. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME of 08A - Oorchg Business As) FACIIJTY ID a 1 %fes'® LOCATION WITHIN SITE (OpticnaO 431 /fs ® ®G EG z�w L TANK DESCRIPTION TANK 10 0 TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes ❑ No c IV N a� ®� it -Yer. complete one page for each Compartment DATE INSTALLED (YEARIMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS (% ADDITIONAL DESCRIPTION (Forlocal use only) U. TANK CONTENTS /' TANK USE 432 /1. PETROLEUM TYPE ❑ 2. LEADED - ❑ S. JET FUEL LY MOTOR VEHICLE FUEL (if marked. Complete Petroleum Type) ta. REGULAR UNLEADED 0 1C. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ Ie. MiOGRAOE UNLEADED ❑ 4. GASOHOL (:199- OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials fn-ntory page) CAS a (from Hazardous Materiats lmrontory page) ❑ 4. HAZARDOUS WASTE (Includes Used 00) 1 (7) 9s UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK 1 SINGLE WALL < ❑ 3.. SINGLE WALLHATH C]5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM ,❑ dem WALL EXTERIOR MEMBRANE LINER C1 95. UNKNOWN " (Check ono only) (y 2. DOUBLE ❑ 4. SINGLE WALL IN A VAULT ❑ 99. OTHER TANK MATERIAL - primary tank C31 BARE STEEL 62"3. FIBERGLASS I PLASTIC C35. CONCRETE ❑ 85. UNKNOYAV (Clock one item aHyl ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ a. FRP COMPATIBLE W/100% METHANOL ❑ 99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank ❑ 1 BARE STEEL EX3 FIBERGLASS / PLASTIC ❑ 8. FRP COMPATIBLE Wf100% METHANOL ❑ 95. UNKNOWN (Check one dear only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD VWFIBERGLASS ❑ 9. FRP NON-CORROOIBLE JACKET ❑ 99. OTHER REINFORCED PLASTIC (FRP) ® 10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LININGATE ❑ 1. RUBBERELINED ❑ 3. EPDXY LINING INSTALLED ❑ S. GULSS LINING 95. UNKNOWN433 OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC UNING ❑ 6. UNLINED ❑ 99. OTHER (For local use ony) (Chock one dem ) DATE INSTALLEO c ❑ 1 MANUFACTURED CATHODIC 3. FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN 434 OTHER CORROSION PROTECTION IF APPUCAB PROTECTION ❑ 4. IMPRESSED CURRENT ❑89. OTHER , (For local use only) (Check one )tem only) ❑ 2. SACRIFICIAL ANODE - YEAR INSTALLED TYPE (1F1orlocalluse OVERFILL PROTECTION EQUIPMENT. YEAR INSTALLED SPILL AND OVERFILL (Check aM mat apply) 'fonly) ❑ t SPILL CONTAINMENT 6 L 1114 W L -0'� ®® ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT - ❑ 3. STRIKER PLATE IV. TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check 1040m orHy): IF SINGLE WALL TANK ed Mot ap ): ❑ PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MTG) ❑ {SINGLE WALL IN VAULT ONLY) 1, VISUAL (EXPOSED ❑ VADOSE ZONE ,Lr4•l/2- 2 CCONTINUOUS INTERSTITIAL MONITORING CONTINUOUS ❑ 2. AUTOMATIC TANK GAUGING (ATG) 6. ❑ MANUAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER 3. ❑ 4. STATISTICAL INV--VTORY RECONCILIATION (SIR) ♦ ❑ 6. TANK TESTING BIENNIAL TANK TESTING (199. OTHER I V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE UST USED (YR/MO/DAY) ESTIMATED OUANTITYOF SUBSTANCE REMAINING 43S TANK FILLED WITH INERT MATERIAL? oanon$ ❑ Yes ❑ No -,..t., CIA/GCR Form