COMPLIANCE INFO_1999-2007 - Laserfiche WebLink

Home Browse Search

IMD PROGRAM CONSOLUDATED FV TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page',of 4 TYPE OF ACTION 0 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION 0 6 TEMPORARY SITE CLOSURE (Check one item only) 0 7 PERMANENTLY CLOSED ON SITE 0 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use Only) [] 8 TANK REMOVED -TOEIOTO =0 ID-_ 0 -Doing Business A,) F BUSINESS NAME(Same.FACILITY NAME or DBA ACiLITY ID: 0 0 0 0 0 0 0 Chevron Station#208118 i oTo-To E LOCATION WITHIN SITE(Optional) 431 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.) --(O-MP-A-R-T--M-E-N-T--A-L-[Z-F-,D--T-A-N-K-7-1-Yes -- TANK ID 4 437 TANK MANUFACTURER 413 NO 434 2 XERXES if'Yes",complete one page for each compartment --- DATE[INSTALLED(Y 0) 435 TANK CAPACITY_IN GALLONS 436 -NUMBER OF COMPARTMENTS 4111 1 107/15/99 115,000 ADDITIONAL DESCRIPTION(For local use only) 411 11.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED 2. LEADED ❑5. JET FUEL (ifinarked complete Petroleum Type) 0 1b. PREMIUM UNLEADED ❑3. DIESEL ❑6, AVIATION FUEL ❑2. NON-FUEL PETROLEUM 1c. MIDGRADE UNLEADED ❑4. GASOHOL C]99.OTHER 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials inventory page) 441 CAS#(from Hazarcluut;Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Includes Used Oil) MID-GRADE UNLEADED 800-61-9 L3 95.UNKNOWN Ill. TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL [33. SINGLE WALL WITH C]5. WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER C]95. UNKNOWN 02. DOUBLE WALL E]4. SINGLE WALL IN VAULT [399. OTHER TANK MATERIAL--primary tank 1. BARE STEEL 03, FIBERGLASS,'PLASTICEITCONCRETE- 0 95. UNKNOWN 444 (Check one:terrt only) ❑2. STAINLESS STEEL [:3 4. STEEL CLAD WIFIBERGLASS []8. FRP COMPATIBLE W/100%METHANOL 0 99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL.-secondary tank -L BARE STEEL.. B 3. FIBERGLASS-W-ASTIC El 5,77ONCRffn�, ❑95, UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL 0 4. STEEL CLAD W/FIBERGLASS 08 FRPCOMPAriBLE W/100%METHANOL [194.0riLR REINFORCED PLASTIC(FRP) []10.COATED STEEL ❑5. CONCRETF, TANK INTERIOR LINING []I.RUBBER LINED 3.EPDXY LIJNG 5.GLASS LINNG [195.UNKNOWN 446 DATE INSTALLED 447 OR COATING 0 2 ALKYD LINING ❑4 PHENOLIC LINING 0 6 UNLINED ❑99 OTHER (check oneacm only) (For 10-1 Use 0111y) [--OTHER CORROSION 0 1 MANUFAC ruRED CATHODIC 3 FIBERGLASS REINFORCED PLASTIC 0 95 UNKNOWN 44S 448 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT 0 99 OTHER Whack one item only) 0 2 SACRIFICIAL ANODE (for local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TY-PE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) 1@ 1 SPILL CONTAINMENT 1999 1 0 1 ALARM 0 3 FILL TUBE SHUT-OFF VALVE 2 DROP TUBE 1999 OPW 61-SO-4 [12 BALL FLOAT 0 4 EXEMPT 3 STRIKER PLATE -Tank Mfg - - - - I - IV.TANK LEAK DETECTION(A description of 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 (Check one item only) 0 1 VISUAL(EXPOSED PORTION ONLY) 0 5 MANUAL TANK GAUGING(MTG) 0 1 VISUAL(SINGLE WALL IN VAULT ONLY) []2 AUTOMATIC TANK GAUGING(ATG) []6 VADOSE ZONE 0 2 CONTINUOUS INTERSTITIAL MONITORING 0 3 CONTINUOUS ATG 0 7 GROUI6DWATFR ❑3 MANUAL-MONITORING [3 4 STATISTICAL INVENTORY RECONCILIATION E3 8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTRAATED DATE LAST USED(YRMO/DAY) : ESTIMATED QUANTITY OF SUBSTANCE REMAINING 116 1 TANK FILLED WITH INERT MATERIAL? 457 71 gallons C3 Yes 0 No UPCF(1/99 revised) 175 Formerly SWRCB Form B