COMPLIANCE INFO_1998-2009 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page L of TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE C] 1 (Check one item only) ❑ 7. PERMANENTLY CLOSED ON SITE u��/1 ❑ 3. RENEWAL PERMIT (Specify reason - for local use only) (Specify charge - for local use only) ❑ 8. TANK REMOVED 430 V90- ) v1 II BUSINESS NAME (Same as FAC�rIrrLITY NAME DaA - Doing Business As) FACILITY 10 # I 1 ��or V NM V I LOCATION WITHIN SITE (Opaonaq 431 'LLA L0 W . i U fxI,%4'et. (�, I..d�. C A Q 514E D�U�f (� - it 1. TANK DESCRIPTION TANK ID # TANK MANUFACTURER `- k 4&vi, \,o COMPARTMENTALIZED TANK Yes ❑ No If -Yes-, complete one page for each compartment. O S VIA DATE INSTALLED (Y R/M0)7 TANK CAPACITY IN LL ONS Com, NUMBER OF COMPARTMENTS 2 lo�q ! ,51000 Vh6n u�„►Q� ADDITIONAL DESCRIPTION (Forlocal use only) If. TANK CONTENTS TANK USE 432 1K1. PETROLEUM TYPE ❑ la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL MOTOR VEHICLE FUEL (if marked, complete Petroleum Type) 1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ 1e MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) CAS # (from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE (Includes Q 0 1 - Used Oil) UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item only) Pt 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑ yg OTHER TANK MATERIAL - primary tank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE 95. UNKNOWN 1 �❑3I (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W/100% METHANOL t>AI 99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary lank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 8. FRP COMPATIBLE W/100% METHANOL ❑ 95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS JK 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. UNKNOWN433 DATE INSTALLED OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6 UNLINED ❑ 99. OTHER (For local use only) (Check one item only) OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑ 95. UNKNOWN 434 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑ 99. OTHER (Check one item only) El 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL %q P- r1 YEAR INSTALLED TYPE (Forlocal use only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 14 Q7 (Check as that apply) IN 1 SPILL CONTAINMENT l'1 1. ALARM M 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE I$L 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE "IV. TANK LEAK DETECTION IF SINGLE WALL TANK ((Check alt that apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): ❑ 1, VISUAL (EXPOSED PORTION ONLY) C15. MANUAL TANK GAUGING (MTG) ❑ 1. VISUAL (SINGLE WALL IN VAULT ONLY) 2. AUTOMATIC TANK GAUGING (ATG) ❑ 6. VADOSE ZONE ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ' ❑ 3. CONTINUOUS ATG - ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) ❑ 8. TANK TESTING BIENNIAL TANK TESTING ❑ 99. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? I, gallons ❑ Yes ❑ No CUPAFORM (4/99) 0 0 Formerly SWRCB Form B