COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORMl� /D t D UNDERGROUND STORAGE TANK "000000, OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one it..only. For an UST permanent closure or removal,complete only this section and Sections I,II,III,IV,and IX below) 430 ® 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION 6.TEMPORARY UST CLOSURE 0 7.UST PERMANENT CLOSURE ON SITE 13 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4Ma DATE EXISTING UST DISCOVERED: 430b W. FACILITY ID# I• ' A (Agency Use lfn(y) 17 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Walmart' BUSINESS SITE ADDRESS 103 CITY 104 3010 W Grant Line Rd Tracy, CA TANK ID# 432 TANK MANUFACTURBIt 433 TANK CONFIGURATION.THIS TANK IS 434 -14 eq, Containment Solutions ❑1.ASTAND-ALONE TANK ❑2.ONE INA COMPARTMENTED UNIT. etearo trreach in the.& DATE UST INSTALLED 433 K CAPACITY IN GALLONS 436 NUMBER O COMPARTMENTS IN THE UNIT 77+7TANK USE Q la.MOTOR VEHICLE FUELING [3 Ib.MARINA FUELING ❑ la AVIATION FUELING 439 ❑3.CHEMICAL PRODUCT STORAGE [34.HAZARDOUS WASTE 0ededa Urea oil) 135.EMERGENCY GENERATOR F(JEL� tsc$25281.5(c)] - L 6.0THER GENERATOR FUEL ❑9S.UNKNOWN 2199.OTHER(3peci ): Us e Cl Nl o 13t o r O i91 t 1 ` CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED 0 la MIDGRADE UNLEADED E31b.PREMIUM UNLEADED 440 1 C33.DIESEL ❑S.JET FUEL [36.AVIATION GAS [38.PETROLEUM BLEND FUEL ❑9.OTHER PETROLEUM 3 440a NON-PETROLEUM:L3 7.USED OIL ❑ 10.ETHANOL 11.OTHER NON-PETROLEUM 4406 TYPE OF TANK 1.SINGLE WALL JN 2.DOUJBIE ALL 9S.UNKNO 443 PRIMARY CONTAINMENT E3 1.STEEL 3.FIBERGLASS 6.INTERNAL BLADDER 444 ❑7.STEEL+INTERNAL LINING 9S.UNKNOWN ❑99.OTHER S 444a SECONDARY CONTAINMENT 1.STEEL ❑3.FIBERGLASS ❑6.EXTERIOR MEMBRANE LINER ❑7.JACKETED 445 ❑90.NONE ❑95.UNKNOWN jU99.OTHER 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS El 2.BALL FLOAT h 3.FILL TUBE SHUT-OFF VALVE 451. ❑4.TANK MEETS XE NTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT ... ,: y� F►`E1i.113i�� 1�r.:�4c'��1T PIPING CONSTRUCTION !.SINGLE-WALLED C3 2.DOUBLE-WALLED ❑99:OTHER 460 SYSTEM TYPE 1.PRESSURE 2.GRAVITY 3.CONVENTIONAL SUCTION 0 4.SAFE SUCTION(23 CCR a)(3) 438 PRIMARY CONTAINMENT I.STEEL ❑4.FIBHRGLASS 8.FLEXIBLE 10.RIGID PLASTIC ❑90.NONE ❑95.UNKNOWN ❑99.OTHER(Specify): 466 SECONDARY CONTAINMENT ® I.STEEL. ❑4.FIBERGLASS ❑S.FLEXIBLE ❑ 10.RIGID PLASTIC 46� ❑90:NONE ❑95.UNKNOWN E3 99.OTHER(Speciw: 466 PIPING/TURBINE CONTAINMENT SUMP TYPE13 1 SINGLE WALL 2 DOUBLE WALT 13 90 NON$ INd 77 VENT PRIMARY CONTAINMENT !.STEEL Ll 4.FIBERGLASS ]0.RIGIDV1 Wgftr 90.NONE U".OTHER(Specify) 464e VENT SECONDARY CONTAINMENT 1. 4.FIBERGLASS El 10.RIGID PLASTIC 0.NONE J3 99.OTHER(Specht 464E 464I VR PRIMARY CONTAINMENT E3 1.STEEL C1 4.FIBERGLASS E3 10.RIGID PLASTIC 13 90.NONE 99.OTHER(Specify) 464a 464 I VR SECONDARY CONTAINMENT C3 1.STEEL 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464h VENT PIPING TRANSITION SUMP TYPE 1.BINDLE WALL 464hl 2.DOUBLE WALL 90.NONE 464L RISER PRIMARY CONTAINMENT 1.STEEL U 4.'FIBERGLASS U 10.RIGID PLASTIC U 90,NONE Ej 99.OTHER(Specify) 464) R[SER SECONDARY CONTAINMENT 1.STEELEj 4.FIDERGLASS 13 10.RIGID PLASTIC 464j] 90.NONE 99.OTHEW-ft lFy) FILL COMPONENTS INSTALLED Q 1.SPILL BUCKET 3,3TRICEIt PLATE/BOTTOM PR R 464k1 4.CONTAINMENT SUMP 451a-c 717 V MAO CONSTRUCTION TYPE ❑ 1.SINGLE WALL ❑2.DOUBLE WALL ❑3.NO DISPENSERS 90.NONE 469a CONSTRUCTION MA ).STEEL. 4.FIBERGLASS !0.RIGID PLASTIC 99.OTHER S 469b-c STffi.COMPONENT PROTECTION ❑2.SACRIFICIAL.ANODE(S) ❑4.IMPItMED CURRENT ❑6.ISOLATION 448. `> .. '; ' >C�a A4isI4.t'slZi►. :. . .,,: _ CERTIFICATION:I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein ht true,accurate, and in full compliance with 1 requirements. SIG RE DATE 470. APPLICANT NAME(print) 471' APPLICANT TI LE 472 Chelsea n ton Maass Permit Cloordinator, BRR Architectur UPCF UST-B-1/2 Rev.(12/2007)