COMPLIANCE INFO_2003-2005 - Laserfiche WebLink

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FIED PROGRAM CONSOLIDATED FOFWU� l' �� UNDERGROUND STORAGE TANKS - TANK P (rtl c TANKS (two pages per tank) Page 14 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 only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID: 1 Quik Stop Market#121 LOCATION WITHIN SITE(Optional) 431 1.TANK�I SCRIRUON (A tk1� p a ldlrtgs a sl lot d 1� subl111tk d,tCt the I TANK ID# N 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK E]Yes ® No 434 ��(� ( St, - Xerxes If"Yes",complete one page for each compartment. DATE INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 (YEAR/MO) 1998/A ril 12,000 1 ADDITIONAL DESCRIPTION(For local use only) 436 (1, 3QNTfNT1 ,. TANK USE 439 PETROLEUM TYPE 446- 0 1. MOTOR VEHICLE FUEL Ella. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked complete Petroleum Type) ®1b. PREMIUM UNLEADED [13. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER_ ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 [14. HAZARDOUS WASTE Unleaded Gasoline (Premium, 91 Octane) 8006-61-9 (Includes Used Oil) ❑95.UNKNOWN .' 111: ANK{i, ;Ni51F�UCt10N" TYPE OF TANK ❑1. SINGLE WALL [13.SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM Y 443 (Check one item only) EXTERIOR MEMBRANE LINER [195. UNKNOWN ®2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT [199. OTHER TANK MATERIAL-primary tank ❑1. BARE STEEL ❑3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ®8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL Cl 3. FIBERGLASS/PLASTIC ❑5. CONCRETE ❑95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL [14.STEEL CLAD W/FIBERGLASS ®8. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED [13.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR 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 ❑95 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 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ®1 SPILL CONTAINMENT 1998 only) ❑1 ALARM ®3 FILL TUBE SHUT OFF VALVE.'199e that apply) - ®2 DROP TUBE 1998 ❑2 BALL FLOAT ❑4 EXEMPT ISI 3 STRIKER PLATE 1998 1±1(Avg nption�ait cal'agency.)' IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 El 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 ®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 _ KC',. .,U. . FtR1i ►TMQt+: E[3MANHN4QII ,N P. 11WN ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING UPCF (1/99 revised) Formerly SWRCB Form B