COMPLIANCE INFO_2008-2018 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TANK 1 (Two pages Per tank) Page_of TYPE OF ACTION 1.NEW PERMIT ❑ 4.AMENDED PERMIT 14 S.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(sum as FACBdTY NAME or DBA-Doing Business As) 3. 1 FACILITY ID: I• HMMMOL OIL Z LOCATION WITHIN SITE(optional) 431. 330 �J H"Met LgNI S-roc iL-IoA) CA 9S2I I 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 QID# Z 432. TANK MANUFACTURER o 433• COMPARTMENTALIZED TANK Yes No 434. -r#1 0 S/SS-3 T 7EE L C-UIIP If`Yes,,,complete am page Por each companmam. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436• NUMBER OF COMPARTMENTS 437. (YEAWMO) 09-01-200c 12,CMAM DO v 2- ADDITIONAL DESCRIPTION(For local use only) 438. II.TANK CONTENTS T.� K NUSE 439• PETROLEUM TYPE 440. /A,�,(' L MOTOR VEHICLE FUEL Ia. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (IfchaJ`°d complete P-Ia-Type) b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (fiom Huardous Materials Inventory page) 441. CAS#(from Harardow Materials inventory page) 442• ❑ 4. HAZARDOUS WASTE (Ineh,des Used Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK [11. 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 tank . BARE STEEL 3. FIBERGLASS/PLASTIC ❑5. CONCRETE13 95.UNKNOWN 444. (Check one item only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC(FRP) W/100%METHANOL TANK MATERIAL-secondary tank 1. BARE STEEL 3. FIBERGLASS/PLASTIC 8. FRP COMPTIBLE W/100%METHANOL 95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEELX4- STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER ` REINFORCED PLASTIC(FRP) ❑10. COATED STEEL 5. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED 3.EPDXY LINING S.GLASS LINING 95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING (O Q.UNLINED ❑99.OTHER Check ore item only) Jk OTHER CORROSION L MANUFACTURED CATHODIC 3.FIBERGLASS REINFORCED PLASTIC 0 95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER If Ecable ❑2.SACRIFICIAL ANODE SPILL AND OVERFIk3. YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION E PMENT: YEAR INSTALLED 452. (Check all that apply) SPILL CONTAINMENT �� .ALARM Z®f3fl �3.FILL TUBE SHUT OFF VALV DROP TUBE 1Lt70O 2.BALL FLOAT_ ❑4.EXEMPT STRIKER PLATE 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 2.CONTINUOUS INTERSTITIAL.MONITORING [13.CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4.STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99.OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE EST[M�ATELAST R/MO/DAY) 455• 1 ESTIM D QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? asZ pitons ❑Yes ❑ No UPCF hwfwrc-b(1/99)-1/4 http://www.unidocs.org Rev.02/16/00