COMPLIANCE INFO_1989-2008 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM TANKS ((( UNDERGROUND STORAGE TANKS -TANK PAGE 1 I' (two pages y -r tank) TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT (Check ons item Doty) 3. RENEWAL PERMIT (Specify Mason - for local use only) BUSINESS NAME (Same as FACILITY NAME of DBA - Doing Business As) LOCATION WITHIN SITE (OpUzasO 431 Page _ of ❑ S. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE ❑ 7. PERMANENTLY CLOSED ON SITE (Speccnjf change. for local use only ❑ 8. TANK REMOVED 430 FACILITY t0 8 'ANK DESCRIPTION COMPARTMENTALIZED TANK ❑Yes ❑ No N4 if -Yes-. complete one page for each compartrrent 1 WOITIONAL DESCRIPTION (Fork CAl use only) ❑ 5. MANUAL TANK GAUGING (MTG) - ❑ 6. VADOSE ZONE ❑ 3. CONTINUOUSATG B. TANK CONTENTS ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ❑ 8. TANK TESTING BIENNIAL TANK TESTING ❑ 99. OTHER TANK USE 432 PETROLEUM TYPE ❑ 2. LEADED ❑ 5. JET FUEL �.,f/' LY 1. MOTOR VEHICLE FUEL Type) ❑ ta. REGULAR UNLEADED L5Y3. DIESEL ❑ 6. AVIATION FUEL (If marked. complete Patroteum ❑ tp. PREMIUM UNLEADED ❑ 99. OTHER ❑ 2. NON -FUEL DETROLEUM - ❑ tc _.OGUNLEADED ❑ 4. GASOHOL ❑ 3. CHEMICAL PROOUCT COMMON NAME (from Hazardous Materials Inventory page) CAS 8 (hem Hazardous Matenats Inventory page) ❑ 4. HAZAROOUS WASTE (Incudes Used Od) 95 UNKNOWN NI. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3.. SINGLE WALL WITH ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM �., / WALL EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ' (Crack ons item Only) Loi' 2. RUBLE � ❑ 4. SINGLE WAIL IN A VAULT ❑ 89. OTHER TANK MATERIAL - primary brk ❑ 1 BARE STEEL 3. FIBERGLASS I PLASTIC ❑ S. CONCRETE [195. UNKNOWN ❑ 99. OTHER (Check aro item only) ❑ 2. STAINLESS STEEL ❑ 44 LAD ❑ 8. FRP COMPATIBLE W1100% METHANOL FADS REINFORCED PLASTIC (FRP) TANK MATERIAL- secondary tank ❑ 1 BARE STEEL E3"3 FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE Wt100% METHANOL ❑ 95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CIAO VAFIBTEIRCGLRSS ❑ 9. FRP NON-CORROOIBLE JACKET ❑ 99. OTHER _ TANK INTERIOR LINING OR COATING (Check or» item only) OTHER CORROSION PROTECTION IF APPLICABLE (Check one item only) SPILL AND OVERFILL (Check a8 Mat apply) REINFORCED PUS ( ) ❑ 10. COATED STEEL ❑ S. CONCRETE DATEINSTALLEO ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING❑95. UNKNOWN. ❑ 2. ALKYD LINING [14. PHENOLIC LINING ❑ c UNLINED u1i9. OTHER (For local use only) 434 DATE INSTALLED ❑ 1. MANUFACTURED CATHODIC 3. FIBERGLASS REINFORCED PLASTIC [195. UNKNOWN PROTECTION ❑ 4. IMPRESSED CURRENT ❑ 99. OTHER (Fwkxai use Doty) ❑ 2. SACRIFICIAL ANODE YEAR INSTALLED TYPE JF,ofW.W useg only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED ❑ 1. SPILL CONTAINMENTL ` �v `� ®A ❑ 1. ALARM ❑ 3• FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE - ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE IV. TANK LEAK DETECTION TANK OR TANK WITH BtADOER (Check ane item only): ❑ 1. VISUAL (EXPOS -ED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MTG) ❑ 2. AUTOMATIC TANK GAUGING (ATG) ❑ 6. VADOSE ZONE ❑ 3. CONTINUOUSATG ❑ 7. GROUNDWATER ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ❑ 8. TANK TESTING BIENNIAL TANK TESTING ❑ 99. OTHER V. TANK CLOSURE INFORMATION ) PER.5IAI ESTIMATED DATE UST USED (YRIMO(DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING gallons IF DOUBLE WALL ❑.,/y( VISUAL (SINGLE WALL IN VAULT ONLY) 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. MANUAL MONITORING IN PLACE 435 TANK FILLEO VATH INERT MATERIAL? ❑ Yes ❑ No