COMPLIANCE INFO_1987-2002 - Laserfiche WebLink

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i•� o\ V,�M 3 �� IFIED PROGRAM CONSOLIDATED FO 3 / /O� Y/ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Pape_of_ 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 orgy) ❑ 8 TANK REMOVED 430 FACILITY ID: 1 BUS ESS NAME(Same as FACILITY NAME or DBA-Doing As) 3 ® r 7 r1 ?3i2C� ea"' [/x LOCATION WITHIN SITE(Optional) 431 I.TANK DENIM6"Caledplclt plan,Witlt tho location of It*UST system inciu*Q buildings end landrnarks ahaY bt a TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yes _No 434 39"2 3 140/0 140 4 I&MOZAJU_. 'LbIAJ6- If*Yes',complete ane papa for each cornpartme t DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3 /! -c 000 ADDITIONAL DE CRIPTION(For local use only) 438 IL TANK CONTENT: TANK USE 439 PETROLEUM TYPE 440 016. MOTOR VEHICLE FUEL [31a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked compete Petroleum Type) Alb. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materiels Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Incudes Used Oil) Q �p ❑95. UNKNOWN ' //IUL+� fJ n'V Ccs r C� IN. TANK CONSTRUC71ON TYPE OF TANK 1. SN'^LF WALL 3.SING!.E WALL WITH 5. SINGLE�,VAL L WITH IN's•I?NAI BLADDER SYSTE.':' T!2 ll.i.e_... l� iThl•+ rr.1C,'!t�9a:Ma33k ANE I.INEk j 0f,, L" -%74 X2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-pnmary tank 1. BARE STEEL [13.-FIBERGLASS/PLASTIC 0 5. CONCRETE 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ;q 4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-second;Ytank 1. BARE STEEL 03. FIBERGLASS/PLASTIC 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 [11.RUBBER LINED ❑3.EPDXY LINING (,5.GLASS LINING [195.UNKNOWN 446 DATE INSTALLEL 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER I (Check one item only) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC[]3 FIBERGLASS REINFORCED PLASTIC 795 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED 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 1K1 SPILL CONTAINMENT /�O+ j that apply) ❑1 ALARM ❑3 FILL TUBE SHUT OFF VALVE 192 DROP TUBE ,�y 092 BALL FLOAT C34 EXEMPT 3 STRIKER PLATE cis a IV.TANK LEAK DETECTION(A description of the morittoring program shall be sutamitted to the local agency.) IF SINGLE WALL TANK(Check all that appy) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 [31 VISUAL(EXPOSED PORTION ONLY (Check one item only) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE UK2 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(YRJMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons ❑Yes ❑ No UPCF (1/99 revised) 0 Formerly SWRCB Form B