COMPLIANCE INFO_2010-2018 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS -TANK PAGE 1 TANKS Pop _ of _ TYPE OF ACTION ❑ 1. NEW SITE PERMIT L14. AMENDED PERMIT 135. CHANGE OF INFORMATION) C36. TEMPORARY SITE CLOSURE (pmc ine aam ow i ❑ 7. PERMANENTLY CLOSED ON SITE ❑ 3. RENEWAL (Specify reason - for local use only) (Specify mange use only) ❑ S. TANK REMOVED 430 BUSINESS NAME (Scone as FACILITY NAME or DBA - DokV Business As) 3 FACILITY IDS 1 S LOCATION WITHIN SITE (Oplione0 qt 1. TANK DESCRIPTION TANK IDS 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK s ❑ No if 'Yes', complete on page eat h cortlPat6nart. 434 DAM INSTALLED(YEAR/MO)y 435 TANKCAPACI 436 NUMBER OF COMPARTMEN7543 �y ADDITIONAL. DESCRIPTION (For local use o*) 438 11. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 eekv��a to 1. MOTOR VEHICLE FUEL ❑ ta. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (Mmaded complete Petroleum Type) pREMiUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ to MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMIOALPRODUCT COMMON NAME (from Hazardous Matenals Inventory Page) 441 CAS # (from Hazardous Malena/s Inventory page) 442 ❑ 4. HAZARDOUS WASTE (Indudes Used 01) ❑ 95. UNKNOWN BI. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL NRH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check am dem only) 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑ 4. SINGLE WALL IN A VAULT ❑ 95. UNKNOWN [199, OTHER TANK MATERIAL -primary tank 1 BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Check one Rem only) 2. STAINLESS STEEL ❑ 4. STEEL CLAD ❑ 8. FRP COMPATIBLE W/100% METHANOL ❑ 99. OTHER W/FIBERGLASS REINFORCED PLASTIC FRP TANK MATERIAL - secondary tank ❑ 1 BARE STEEL 1`03. FIBERGLASS / PLASTIC ❑ 8. FRP COMPATIBLE W/l00% METHANOL ❑ 95. UNKNOWN 445 (Check are aero only) ❑ 2. STAINLESS STEEL 4, STEEL CLAD W/FIBERGLASS ❑ 9. FRP NON -CORRODIBLE JACKET ❑ 99. OTHER REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING q_11. UNLINED ❑ 99. OTHER Check are Rema For local use only) OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC 133. FIBERGLASS REINFORCED PLASTIC 5. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑ 99. OTHER (Check are Ren only) ❑ 2. SACRIFICIAL ANODE (For local use oMy) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT. YEAR INSTALLED 04 452 (Check all that apply) 'M 1. SPILL CONTAINMENT ❑ 1. ALARM I 3. FILL TUBE SHUT OFF VALVE f OC { 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4 EXEMPT STRIKER PLA) N. TANK LEAK DETECTION IF SINGLE WALL TANK (Check as that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 ❑ 1. V;S'cAL (EXPOSED PORTION ONLY) ❑ 5. MANUAL TA`.< GAUGING (MTG) ❑ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING (ATG) ❑ 6. VADOSE ZCNE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTNUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) • ❑ 8. TANK TESTING BIEN%iAL TANK TESTING ❑ 99. OTHER V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED CATE LAST USED (YR/MOIDAY) 455 ESTIMATED QUANTITY Dx SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑ Yes ❑ No UPCF (1/99) Formerly SWRCB Form 8