COMPLIANCE INFO_2002-2008 - Laserfiche WebLink

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• 0 UNIFIED PROGRAM CONSOLIDATED FORM ?�c,\o3 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 °\, (two pages per Lank) TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANGE OF INFORMATION Page of "' \\\ ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT' (Snecifv reason - r., 1-1'. -d.n (Q., ;r.. e a r . r -I BUSINESS NAME (Same as FACILITY NAME or DBA -- Doing Business As) FACILITY ID: v✓ l V 1 USA GASOLINE #3 50a- 0a LOCATION LOCATION WITHIN SITE (optional) 431 L 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 ID # 432 NUFACTURER 433 TANK MA COMPARTMENTALIZED TANK [-]Yes ® No 434 �5 TRUSCO If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 1995 10000 437 ADDITIONAL DESCRIPTION (For local use only) 438 II. TANK CONTENTS TANK USE A39 PETROLEUM TYPE ® I. MOTOR VEHICLE FUEL nao ❑ I a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5 JET FUEL (If marked completePetrolewn'rype) ❑lb. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM 0 Ic. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page) 442 134 HAZARDOUS WASTE (Includes Used Oil ❑ 95. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN 0 2. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL -primary tank ® I. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS [18 FRPCOMPTIBLE W/100% METHANOL ❑ 99 OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL -- secondary tank ❑ 1. BARE STEEL 3. FIBERGLASS/ PLASTIC 0 5. CONCRETE ❑ 95. UNKNOWN 445 (Check one item only) ❑ 2. STAINLESS STEEL ® 4. STEEL CLAD W/FIBERGLASSo ❑ 8. FRP COMPTIBLE W/100% METHANOL ❑ 99. OTI-IER REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING El I. RUBBER LINED 0 3. EPDXY LINING 5. GLASS LINING 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ®6 UNLINED ❑ 99 O'TI IE R (Check one item only) (For local use only) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN A48 448 PROTECTION IF APPLICABLE PROTECTION ❑ 4IMPRESSED CURRENT ❑ 99 OTHER (Check one item only) ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ® I SPILL CONTAINMENT 1995 ® 2 DROP TUBE 1)95 ❑ 1 ALARM ®3 FILL TUBE SHUT OFT VALVE ❑ 2 BALL FLOAT ❑ 4 EXEMPT ® 3 STRIKER PLATE 1995 IV. TANK LEAK DETECTION (A description of the 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 ❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (MTG) (Check one item only) ❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING (ATG) ❑ 6 VADOSE ZONE 0 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ❑ 3 MANUAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER IV. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/I TIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑ Yes ❑ No UPCF (1/99 revised) Formerly SWRCB Form B