COMPLIANCE INFO_1987-2002 - Laserfiche WebLink

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i "IED PROGRAM CONSOLIDATED F010 TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (Two pages per tank) Page_of TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT OK 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSINS NAME(Same as FACILI NAME or DBA-Doing Business As) 3. FACILITY ID: 1. �^ LOCATION WITHIN SITE(Optional) 431 I.TANK DESICRIPTIUN {A c ed plot Iarl°with the location of tF►e UST systelm iltctuiiid bvlldlid tattdmarks;sll lIto''submitted to the local envy) TANK ID# 43/2'. TANK MANUFACTURER 433. COMPARTMENTALIZED TANK Yes No 434.' jy 0 o0t 1-J 1 1q0 q0 1 q0 y0VpD"/1.7 tx) If"Yes,"complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS I ,) 437. ADDITIONAL DESCRIPTION(For local use only) 438. II.TANK,CONTIt,KU „�33,r TANK - USE 439. PETROLEUM TYPE aao. ❑ 1. MOTOR VEHICLE FUEL ❑1 a. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (If checked,complete Petroleum Type) ❑lb. PREMIUM UNLEADED [13. DIESEL [16. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL K99.OTHER: // OV12 QI/L ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441. CAS#(from Hazardous Materials Inventory page) 442. [g 4. HAZARDOUS WASTE eludes Used Oil) ❑ 95.UNKNOWN pi 0 To/'! O TIL TAW CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) MEMBRANE LINER ❑95. UNKNOWN 2. DOUBLE WALL ❑4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tank Lj 1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL '04. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC(FRP) W/100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445. (Check one item only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED El 3.EPDXY LINING 5.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING [14.PHENOLIC LINING R6.UNLINED ❑99.OTHER (Check one item only) 13/" OTHER CORROSION ❑1.MANUFACTURED CATHODIC ❑3.FIBERGLASS REINFORCED PLASTIC R 95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT 99.OTHER (If Applicable) ❑2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAROVERFILLALLED aso. TYPE a51. PROTECTION EQUIPMENT: YEAR INSTALLEDa452. (Check all that apply) 1.SPILL CONTAINMENT [11.ALARM [13.FILL TUBE SHUT OFF VAL 2.DROP TUBE IX 2.BALL FLOAT ❑4.EXEMPT 3.STRIKER PLATE IY TANS LEAK DETECTION A descxi titan of the monitoring prog€a n shatlte,saibmitte€i to the local,' ency} IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑1.VISUAL(EXPOSED PORTION ONLY) [15.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE Cd 2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG [-17.GROUNDWATER ❑3.MANUAL MONITORING ❑4.STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99.OTHER "TANK CLOSURE INFORITIO f PE � T G FLACE • ': ," :,, i,,, .,. '..., „_• ._... :x,33,,......I31 _„ ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITI3 INERT MATERIAL? 457. gallons []Yes ❑ No UPCF hwfwrc-b(1/99)-1/4 • http://www.unidocs.org Rev.02/16/00