COMPLIANCE INFO_1986-2003 - Laserfiche WebLink

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1 FROM JIM THORPE OIL, INC. • FAX NO. : 209 368-1851 • Dec. 19 2002 03:01PM P2 UNIF)(F;D PROGRAM CONSOLIDA'T'ED FORM 1011 UNDERGROUND STORAGE TANKS—TANK ,PAGE 1 'TANKS -14 (two pages per Oink) page_ <,r TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CI IANGE Or INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one iterhooy) -^ •-- � O 7 PERMANENTLYCLt1SEDON SITE 3 RINNF AL PERMIT (Specify rca3Ma—Cor local aae only) (Specify reaaen—for local ttye unly) ❑ g TANK REMOVF.1) 43() BUSINESS NW.(titnm ax rnCI11Y'Y NAME or DSA-lkiint;Business Ac) FACILITY ID; ) r 1 7 7 LOCATION WITHIN SITE(Optional) � 431 X51 N, eC _n ( LVCL , f�l �5�41 I.TANK DESCRIPTION (A stilled plot plats with the location the UST syslern including building,and landmarks shall be SubMilted to the local a en s cy.) IT,yANK JD JI 432 TANK MANUFA,C/TURER 43,1 COMPARTMENTALIZE TANK Q Yc, i�lo 434 31 o � /c CPO If^Yea wmplete one page thr tach comparuKN. DATF.INSTALLED(YE;RWMU) 435 TANK CAPACITY N GALLONS 436 NUMBER OF COMPARTML N"TS 437 96 O ADDITIONAL DESCRIPTION(Por local utc only) 438 TI.YANK CONTENTS ,.,/TANK USE 439 PETROLEUM TYPE IS 1. MOTOR VEHICLE FUEL. Ej la, REGULAR UNLEADED ❑2. LEADED ❑S. JET FUEL (IfmarkmeoeK,)ctcPetroleum Type) ❑Ib. PREMIUM UNLEADEllD1 !j�hSEL ❑6. AVIATION FUEL Q 2, NON-FUEL PETROLEUM ❑1c. MWORADE UNLEADED ❑4. GA8UHOI, p 99,OTHER In 3. CHEMICALPRODUCT COMMON NAME or rallacardoaa Materials inventorypaec) 441 CAS#(froth HaardousMater"inrtraorypage) 442 E14. I IAZAR nnus WASTE (Inuludes Used<);q ❑95,UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK ❑I. SINGLE WALT. [13. SINGLE WALL WITH ❑$. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER Cl 95. UNKNOWN tJBLE WALT. ❑4. SIGNLE WAIL IN VAULT 0 99. OTHER TANK MATERIAL primary tank VI. 13ARF.STEEL 3. nPERGLASS/PLAsnC 0 5. CONCRETE Ll 95. UNKNOWN 444 (Check one Item only) ❑2. STAINLESS STEEL rRPL CLAD W/F7BE•RGLASS 0 S. rRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TAMC MATERIAL secmxLpy sank ❑). HART STEEL ❑3. FI RGLASS/PLASTIC 5. CONCRETE ❑95. UNKNOWN 445 (CTe4k um item only) ❑ �_�2. STAINLESS STEEL �C STF'EL CLAD W/FIDERGLASS 09. FRP COMP'fIHLE W/l00%METHANUL 099.OTHER REINF(3RCEI)PLASTIC(MRP) 0 10.COATED STEEL Q 5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED 0 3,EPDXY LINING, ❑5.GLASS LINING ❑95.UNKNOWN 446 DATE,INSTALLED 441 OR C'OA'r1NG ❑2 ALKYD LINING ❑4 PHENOLIC LINING M<15LINED ❑99 OTHER (Check oep horst only) (Por tow ttdo only) OTHER CORROSION [7 i MANUFACTURED CATHODIC i rinFRGLASs REINrORCED PLASTIC ❑95 UNKNOWN l48 DATE 1NSTAI.I,ED 449 PROTECTION IF APPLICABLE PROTI:G'TION 0 4IMPRESSED CURRENT ❑99 OTHER (Check one nem only) ❑2 SACRIFICIAL ANUDE (For Inoal use only) SPILL AND OVPRFII.I. YEAR INSTALLED 4" TYPE(looxl w only) 451 OVERFILL PROTF.CTION EQUIPMENT;Y AR INSTALLED 452 ({:Wk all Thal apply) OKS L CONTAINMENT ❑! ALARM FILL TURF SHUT O1T VALVE 2 1AOP TUBE. 0 2 BALL FLOAT ❑4 EXEMPT STRIKER PLATE IV.TANK LEAK DETECTION(A 44auription of the maahering program shall be z l maned to the local agatey,) 1F SINGLE WALL TANK(Chuck all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 4S4 (Check one nem only) []1 VISUAL(EXPOSED PORTION ONLY) Q 5 MANUAL TANK GAUGING(MTC) ❑i VISUAL(SINGLE WALL,IN VAULT ONLY) ❑2 AuTOMATIC TANK GAUGING(ATG) ❑6 VADOSF,ZONE p 2 CONTINUOUS INTFRSTITIAL MONITORING; ❑3 CONTINUOUS arc ❑7 GROUNDWATER ❑3 MANUAI.MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION 118 TANK TESTING (SIR) RIGNNIAL TANK TESTING ❑"OTHER IV.TANK CLOSURE INI?OILNIATION/PERMANENT CLOSURE IN PLACE ESTIMATFI.)DATE LAST USED(YIUMOIDAY) 455 L•STIMATED QUANTITY Of SUBSTANCE REMAINING S5( TANK FILLED WITH I,vERT MATMLAL? 457 gallons ❑Ycs ❑ No LTPCF(12/99 revised) Formerly SWRCB Form 13