COMPLIANCE INFO_1999-2007 - Laserfiche WebLink

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UNW PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) TYPE OF ACTION ElPage_of_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 \`p\l�/J /� �{S l� BUSINESS NAME(Same as FACILMY NAME or DBA-Doing Business As) FACILITY ID: f 1 r . 1 ._ tC7i � Cct.tr<4�oc�t✓ - C ,�zt� t,)c 3 LOCATION WITHIN SITE(Optional) I 1,31q1716 431 I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# .S a32 TANK MANUFACTURER 433 /� n _ COMPARTMENTALIZED TANK [I Yes No 434 _3 I o t©d e,v yl e(O!t� �j �, ,Tye If"Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 1. MOTOR VEHICLE FUEL ❑la REGULAR UNLEADED ❑2. LEADED [IS. JET FUEL aao (If marked complete Petroleum Type) ❑lb. PREMIUM UNLEADED X3. DIESEL [16. AVIATION FUEL ❑2.NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Includes Used Oil) i ❑95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK I. SINGLE WALL 3. SINGLE WALL WITH U S. SINGLE-WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER Q 95.UNKNOWN 92. DOUBLE WALL [14. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank pq 1. BARE STEEL U 3. FIBERGLASS/PLASTIC El 5. CONCRETE 0 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL r]4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL [:199.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank 0 1. BARE STEEL 3. FIBERGLASS/PLASTIC US. CONCRETE 0 95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL K4. STEEL CLAD W/FIBERGLASS 1:18- FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING U 1.RUBBER LINED El 3.EPDXY LINING U 5.GLASS LINING D 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING (Check one item only) El6 UNLINED ❑99 OTHER (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 ly 450 TYPE pocal use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED q ( 452 (Check all that apply) 10 1 SPILL CONTAINMENT �j Q 2 DROP TUBE 1 ALARM CC3 FILL TUBE SHUT OFF VALVE ❑2 BALL FLOAT ❑4 EXEMPT 3 STRIKER PLATE IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) 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 C;1.3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMIATIrON/P�ERINAANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRMIO/DAY) 4'5 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons :3 INERT ElNo UPCF(12/99 revised) 10 Formerly SWRCB Form B