COMPLIANCE INFO_2012-2018 - Laserfiche WebLink

Home Browse Search

t.f1 3`.t, MRVIED PROGRAM CONSOLIDATED FO. , UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) /moi TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section andSections I,1l,III,lV,and/X below) 430. ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a. DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATIONty FACILITY ID 8(Agency Use Only) BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) a 3 Shell/Tesoro 68150 1 BUSINESS SITE ADDRESS 103. Loc 13975 E. Hiway88 Loc keford II. TANK DESCRIPTION TANK ID tl 432. TANK MANUFACTURER 433 TANK CONFIGURATION:THIS TANK IS 434. i. r ASTIP ® 1.A STAND-ALCINE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437. 1990 10,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(includes Used oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(0)[ __ ❑ 6.OTIIE_R GENERATOR FUEL _ ❑ 95.UNKNOWN_ 9 .OTHER(Specify): 439& CONTENTS PETROLEUM: ❑ la REGULAR UNLEADED ❑ tc.MIDGRADE UNLEADED ® lb.PREMIUM UNLEAfI- 440. ❑ 3.DIESEL ❑ 5.JET FUEL As Nom! ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440x. NON-PETROLEUM:❑ 7.USED OIL ❑ t0.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK _ ❑ 1.SINGLE WALL ® 2.DOUBLE WALL _❑ 95.UNKNOWN443 PRIMARY CONTAINMENT �® L STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING _ ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444x. SECONDARY CONTAINMENT ❑ 1.STEEL ❑3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ® 7.JACKETED v�445. ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445*. OVERFILL PREVENTION ❑ 1.AUDIBLE&VISUAL ALARMS [1 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ I.SINGLE WALL ® 2.DOUBLE WALL 0 99.OTHER _ 460. SYSTEM TYPE _ _® L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(ax3)I 458.- PRIMARY CONTAINMENT 0LSTEEL ® 4.FIBERGLASS El S.FLEXIBLE ❑ 10.RIGID PLASTIC 4ti4 C] 90.NONE _ _❑_95.UNKNOWN_ _❑_99.OTHER x. �(Specify): 464 SECONDARY CONTAINMENT ❑ I STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC V�4646 _ ___ ❑ 90.NONE _ ❑ 95.UNKNOWN_ [199.OTHER(Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE a64d. VI. VENT, VAPOR RECOVERY(VR) AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT 464e T _ _ _® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464el_ VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464f _ 464n-- VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS` ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464g' VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC 19 90.NONE ❑ 99.OTHER(Specify): 464h' _ 464hl._ VENT PIPING TRANSITION SUMP TYPE__ '❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 90 NONE 4641. RISER PRIMARY CONTAINMENT_ -'® L STEEL El 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99,OTHER(Specify): 4641' _ a6a'I. RISER SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS Cl 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464k- 464k I FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATEBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL [12.DOUBLE WALL 0 3.NO DISPENSERS 0 9_0.NONE 469a, -CONSTRUCTION MATERIAL' ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) `T 469b. 469c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ® 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 443 IX APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE DA 4/28/2011 470 APPLICANT NAME(print) Sandy Awards 471. APPLICANT TITLE Environmental Compliance 472' UPCF UST-B Rev.(12/2007)-1/2 ,Yww.unidGcs org