COMPLIANCE INFO_2000-2006 - Laserfiche WebLink

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FIED PROGRAM CONSOLIDATED FO - 11 1 TANKS UNDERGROUND STORAGE TANKS - TANK P E 1 �2�� 8�03 (two pags per tank) Page t, 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: Quik Stop Market #125 1 LOCATION WITHIN SITE (Optional) 431 L TAN WDgL RtPTION , (AS � is nth the � � tJS T � �� I� buildings and �ar�s shall tis �ubrr� tc� e �4.5 N�.,. ... , TANK ID # 432 433 TANK MANUFACTURER COMPARTMENTALIZED TANK E] Yes ® No 434 3 14 Q ! N 74 0 3 Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 (YEAR/MO) 1985/March 8,000 1 ADDITIONAL DESCRIPTION (For local use only) 438 A: TANF., S,E TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL [Ila. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If marked complete Petroleum Type) ❑ lb. PREMIUM UNLEADED 03. DIESEL ❑ 6. AVIATION FUEL [12. NON -FUEL PETROLEUM ❑ 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER_ [13. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page) 442 ❑ 4. HAZARDOUS WASTE Diesel Fuel 68476-34-6 (Includes Used Oil) ❑ 95. UNKNOWN Its Thi 6NTRllGTi01 : ', TYPE OF TANK ❑ 1. SINGLE WALL [13. SINGLE WALL WITH [15. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [195. UNKNOWN 02. DOUBLE WALL ❑ 4. SIGNLE WALL IN VAULT [:199. OTHER _ TANK MATERIAL -primary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC [:15. 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 [13. FIBERGLASS / PLASTIC [15. 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 [:15. CONCRETE [110. COATED STEEL TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING [15. GLASS LINING [195. UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED [:199 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 only) (Check all ® 1 SPILL CONTAINMENT 1998 [:11 ALARM ® 3 FILL TUBE SHUT OFF VALVE : t 5 W that apply) - ® 2 DROP TUBE 1998 ❑ 2 BALL FLOAT ❑ 4 EXEMPT ® 3 STRIKER PLATE 1985 11/. .gnl utteto thaTANC geracy.), IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑ 1 VISUAL (EXPOSED PORTION 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 [:18 TANK TESTING + (SIR) BIENNIAL TANK TESTING ❑ 99 OTHER - os t? ►I�! ? Iw 'roc _y I ANENT CLOSUREtt P cI :+ , , ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 458 TANK FILLED WITH INERT MATERIAL? 457 REMAINING UPCF (1/99 revised) Formerly SWRCB Form B