COMPLIANCE INFO_1987-2002 - Laserfiche WebLink

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NIFIED PROGRAM CONSOLIDATED Fir -NONUNION 3�I q/02"TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page_or_ TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 BU IN S NAME(Same as FACILITY NAME or DBA-Doig Business As) FACILITY ID: /' 1 LOCATION WITHIN SITE(optional) 431 I.TANK DESCRPTM46(441061led phot plan;willt tt WCation of ft UST system indu&Q bukirligs and landmarks shay bit a TANK ID# j 432 TANK � MAN�Ur,F�ACT�pURER 433 COMPARTMENTALIZED TANK Yes No 434 39eWa3140g0 J4 //� qo.3 (;?j)&n/j' �C�-I�//i1�� If*Yes',complete one page for each compartmot DATE INSTALLED(Y AR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3 4 ADDITIONAL DESCRIPTION(For local use only) 430 IL TANK CONTENW. TANK USE 439 PETROLEUM TYPE 440 Qg,1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked complete Petroleum Type) ❑tb. PREMIUM UNLEADED ❑3. DIESEL ❑8. AVIATION FUEL [12. NON-FUEL PETROLEUM ;K1C. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Haardau Materials inventory pegs) 442 ❑4. HAZARDOUS WASTE (Includes Used Oil) ❑95. UNKNOWN lNta✓ e �V- / t; IN. TANK CONSTRUC71ON TYPE OF TANK ❑ SINGLE WALT. 0 3.SINGLE WALL WITH Ll 5. SINGLE WALL WITH INTERN.'-' ;a.A!)^GR SYSTEM 4!.3 L�1 o3. tin,.�f.jOW A2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-pnmary tank C1 1. BARE STEEL CY3. FIBERGLASS/PLASTIC 0 5. CONCRETE 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL X4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secondary tank 1. BARE STEEL [T3. FIBERGLASS/PLASTIC C3 5. CONCRETE C1 95. UNKNOWN 445 (Check one Item only) ❑2. STAINLESS STEEL ❑4.STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE [110.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING �5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLEC 447 , T COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC❑3 FIBERGLASS REINFORCED PLASTIC ;k95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For Idyl use only) SPILL AND OVERFILL YEAR INSTALLLgD 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 'If' 452 (Che /15-1-vckall P(1 SPILL CONTAINMENT � -v j that apply) ❑1 ALARM ❑3 FILL TUBE SHUT OFF VALVE K2 DROP TUBE ,r %2 BALL FLOAT ❑4 EXEMPT 3 STRIKER PLATE �Of IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to ttx 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) [3MTG 5 MANUAL TANK GAUGING (Check one item only) ( ) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) Cl 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ;92 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/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons [:]Yes ❑ No UPCF(1/99 revised) Formerly SWRCB Form B