COMPLIANCE INFO_1988-2007 - Laserfiche WebLink

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AdINL IFIED PROGRAM CONSOLIDATED FORMW T S UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page;��xv TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT E] PagV m 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE(Check only iteonly) ❑ 7 PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT _ ❑8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: 1 TWO GUYS FOOD&FUEL** 3 FA0003789 1 PR0232353 TMI 11H 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# 3.00 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes [-]No a34 TA0235303 If^Yes",wmplete one page for each compartment. DATE INSTAL LED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 l � 10,000 ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS ANK USE 439 PETROLEUM TYPE 440 1.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (If marked complete Petroleum Type) ❑ lb.PREMIUM UNLEADED ® 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ❑ 1 c.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 ❑ 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) j EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN 2.DOUBLE WALL ❑ 4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank 1.BARE STEEL ❑ FI RGLASS/PLASTIC ❑ S.CONCRETE ❑ 95.UNKNOWN 444 (Check one item only) ❑ 2.STAINLESS STEEL TEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL .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 ❑ 5.GLASS LINING447 OR COATING ❑ 95.UNKNOWN 446 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 449 PROTECTION IF APPLICABLE PROTECTION ❑ 3 FIBERGLASS REINFORCED PLASTIC E]95 UNKNOWN 4a8 DATE INSTALLED (Chock one it-only) ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL 91,11DROP tI YEAR INSTALLED 450 TYPE poral use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED y y 452 (Chink all that apply) PILL CONTAINMENT ❑ 1 ALARM ❑✓41LL TUBE SHUT OFF VALVE TUBE ❑ 2 BALL FLOAT ❑ 4 EXEMPT STRIKER PLATE IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Chink 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 it-only) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER �2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑3 MANUAL MONITORING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING asb TANK FILLED WITH INERT MATERIAL? 457 gallons ❑ Yes ❑ No UPCF(12/99 revised)