COMPLIANCE INFO_1988-2007 - Laserfiche WebLink

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FIED PROGRAM CONSOLIDATED FORMIP �1 UNDERGROUND STORAGE TANKS - TANK PAGE 1 A �es ertarik)- TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSUREPage 5 0f1Q. (Check only item only) ❑ 7 PERMANENTLY CLO D ON SIT® 3 RENEWAL PERMIT r-r= t) t ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: l TWO GUYS FOOD&FUEL** 3 FA0003789 PR0232353 c� LOCATION WITHIN SITE(Optional) 147 E LATHROP RD,LATHROP 431 PHONE?', 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# 2.00 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑ Yes 2-Ko 434 TA0235302 If"Yes",complete one page for each compartment. DATE INSTALLEDD((YEAR/MO) 435 TANK CAPACITY IN GALLONS a36 NUMBER OF COMPARTMENTS 437 q" 10,000 ADDITIONAL DESCRIPTION(For local use only) 438 H.TANK CONTENTS ANK USE 439 PETROLEUM TYPE 440 I.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (Ifmarked complcte Petroleum Type) ® Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ lc.MIDGRADE UNLEADED ❑4.GASOHOL ❑ 99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAMEfrom Hazardous Materials Inventory ry page) 441 CAS#(from Hazardous Matmak Inventory,page) 442 ❑ 4.HAZARDOUS WASTE (Includes Used Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank 1.BARE STEEL ❑ FIB RGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Check one item only) E] 2.STAINLESS STEEL PEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check one item only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 1.RUBBER LINED 3.EPDXY LINING 447 OR COATING ❑ ❑ 5.GLASS LINING ❑ 95.UNKNOWN aa6 DATE INSTALLED (Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ❑ 6 UNLINED ❑ 99.OTHER (For local use only) OTHER CORROSION ❑ 1 MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN a48 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check one item only) ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL ` YEAR INSTALLED 450 TYPE(locat use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED L O 452 (Check all that apply) PILL CONTAINMENT ❑ I ALARM 2-1 FILL TUBE SHUT OFF VALVE ROP TUBE ❑ 2 BALL FLOAT ❑ 4 EXEMPT 3 STRIKER PLATE IV.TANK LEAK DETECTION(A description ofthe 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 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER Y2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING F-199 OTHER [:]3 MANUAL MONITORING V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ❑Yes ❑ No UPCF(12/99 revised)