COMPLIANCE INFO_1986-2004 - Laserfiche WebLink

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• i. �� Ur.IFlED PROGRAM CONSOLIDATED FOR , ' TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (two pages per tank) r Page _ 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 'v 3.RENEWAL PERMIT (Specify reason-for local use only) (Specify change-for local use only) ❑ S. TANK REMOVED 430 O BUPtVESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY IDN I'mi- LOCATION #WITHIN TE(OPRoneqL !/ d 1?'- q M /s1.TANK DESCRIPTION TANK ID# l G� y 7Gs'✓"�T TANK MANUFACTURER r- COMPARTMENTALIZED TANK Yes ❑ No la /s• 3 3� v t&SL 1� _A If'Yas',complete one page for each compartment. DATE INSTALLED(YEARiMO) 7 TANK CAPACITY IN GALLONS 7�'� NUMBER OF COMPARTMENTS HIM 2 �� ADDITIONAL DESCRIPTION(Forlocal use only) *:k IL TANK CONTENTS TANK USE 432 PETROLEUM TYPE 10.1. MOTOR VEHICLE FUEL ia. REGULAR UNLEADED ❑nn 2. LEADED ❑ 5. JET FUEL (ll marked,complete Petroleum Type) Ib. PREMIUM UNLEADED ,LA 0. DIESEL ❑ 8. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑1c.MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME(/mm Hazardous Materials Inventory page) CAS#(from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE(Includes Used Oio 1 1195, UNKNOWN 111.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check on@ item only) 'L 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 1195. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN (Check one Rem only) CW_2.STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W/100%METHANOL 1199. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank ❑ 1 BARE STEEL p(j. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE W/100%METHANOL 1195. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOVM433 DATE INSTALLED OR COATING ❑ 2.ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6. UNLINED ❑99. OTHER (Check one Rem only) � For local use on OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC J`-"'. UNKNOWN 434 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (Check one item only) ❑ 2. SACRIFICIAL ANODE (Forlocal use only) SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check all that apply) �'1 SPILL CONTAINMENT 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE K2. DROPTUBE 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE �' ...FV.�'1TkNK�.EAK"DETECTION. IF SINGLE WALL TANK(Check all that apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item onl : VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE 4ZL 2. CONTINUOUS INTERSTITIAL MONITORING 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING 4. STATISTICAL INVENTORY RECONCILIATION(SIR)r ❑ 8. TANK TESTING BIENNIAL TANK TESTING El 99. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) - ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? gallons ❑Yes ❑No CUPAFORM(4/99) Formerly SWRCB Form B