COMPLIANCE INFO_1999-2008 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FORM II(two pages per tank) (I Page _ of TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check one dem only) ❑ 7. PERMANENTLY CLOSED ON SITE ❑3.RENEWAL PERMIT (Specify reason - Mrlocaluseonly) (Specify change- for loco/ use only) Cl B. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY ID # �< LOCATION WITHIN SITE (Optionan 431 n (.TANK DESCRIPTION TANK ID # TANK MANUFACTURER COMPARTMENTALIZED TANK A Yes ❑ No p - / -rno If'Yes', complete one page or each compartment. DATE INSTALLED (YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS O ARTMENTTS5 &5 C; ADDITIONAL DESCRIPTION (Forlocal use only) Ij If. TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ Ia. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL 1. MOTOR VEHICLE FUEL (If marked, complete Petroleum Type)1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM 11tc. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER 11 3. CHEMICAL PRODUCT COMMON NAME lhom Hazardous Materials Inventory page) CAS # (trom Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE (Incudes - Used Oil) UNKNOWN 95, III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one dem only) .DOUBLE WALL EXTERIOR MEMBRANE LINER ❑ 95. 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 item only) ❑ 2. STAINLESS STEEL STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W/100% METHANOL ❑ 99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank ❑ 1 BARE STEEL 3. FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE W/100% METHANOL ❑ 95. 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. UNKNOWN433 DATE INSTALLED OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING6. UNLINED ❑ 99. OTHER (Check one dem only) (For local use only) OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC 13 3. FIBERGLASS REINFORCED PLASTIC ❑ 95. UNKNOWN 434 DATE INSTALLED 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 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 ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE I\[J 3%►NK LEAK"DETECTION. IF SINGLE WALL TANK Check all that apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER (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. CONTINUOUSATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ❑ 8. TANK TESTING BIENNIAL TANK TESTING ❑ 99, OTHER 1 A7 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 J r e CUPAFORM (4/99) Formerly SWRCB Form B