COMPLIANCE INFO_2008-2018 - Laserfiche WebLink

Home Browse Search

1000 UNIFIED PROGRAM CONSOLIDATED FO d T/yl- OPERATING UNDERGROUND STORAGE TANK PERMIT APPLICATION-TANK INFORMATION(One form UST) TYPE OF ACTION (Check one item only. For anpermanent closure or removal,complete only this section and Sections I,II,III,IV,and IX below) 430 ❑ 1.NEW PERMIT 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ _ 1 BUSINESS NAME(Same as FAC IL TYNy t BA- n Bus' 3 BUS SS SITE ADDRESS 103 CITY 104 o LZ o S+ �-�o C A- �S 7-� H.TANK DESCRIPTION TANK ^�ID//�#) /,,/{� 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 -r 1 v�/D T-& J Z t �� O[ ONE!A COMPAR LONE TANK UNIT. Complete one page for each cornparlinent in the unit DATE UST SYSTEM INSTALLED 435 TANK C1r CITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 '7 M.TANK USE AND CONTENTS TANK USE Qfa.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATO L ❑ 95.UNKNOWN ❑ 99.OTHERS OTHER(Specify): 439a CONTENTS PETROLEUM: SKa.REGULAR UNLEADED ❑ Ic.MIDGRADE UNLEADED ❑ lb.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM $ 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS 440b , TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT Q-t-STEEL W !FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERN L G ❑ 95.UNKNOWN ❑ 99.OTHER (Spec;*): 444a SECONDARY CONTAINMENT ❑ L STEEL ERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445 ❑ 90.NONE 5.UNKNOWN ❑99.OTHER(Specify) 445a OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT FII.L TUBE SHUT-OFF VALVE 452. ❑4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V PROIIU t WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑L INGLE-WALLED Qr2.DOUBLE-WALLED --099.OTHER 460 SYSTEM TYPE .PRESSURE 132. RAVTTY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(ax3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑90.NONE ❑ 95 UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 ❑ 90.NONE ❑ 2X UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGITUR BINE CONTAINMENT SUMP TYPE GrI.SINGL. EWALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644 VL VENT,VAPOR RECO (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT U 1.STEEL Ur4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464e 464e1 VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4641' 464fl VR PRIMARY CONTAINMENT ❑ 1.STEEL .FIBERGLASS ❑ 10.RIGID PLASTIC 0. E ❑ 99.OTHER(Specify) 4648 VR SECONDARY CONTAINMENT ❑ 1.STEEL 0 4.FIBERGLASS ❑ 10.RIGID PLASTIC90 NE ❑ 99.OTHER(Specify) 4640 464h 464hl VENT PIPING TRANSITION SUMP TYPE INGLE WALL Q 2.DOUBLE WALL 1&2WITONE 464i. RISER PRIMARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS U 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Specify) 464j 464'1 S RISER SECONDARY CONTAINMENT 1. EL 4.FIBERGLASS 10.R1GIDPLASTIC .NONE 9-.OTHER(Specify) 464k 464kI FILL COMPONENTS INSTALLED .SPILL BUCKET .STRIKER PLATE/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 45lac .UNDER DISPENSER CONTAINMENT:(UDC) CONSTRUCTION TYPE 1.SINGLE WALL ❑2.DOUBLE WALL [13.NO DISPENSERS [390.NONE 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS jin.RIGID PLASTIC ❑ 99.OTHER(Specify) 469bc VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑4.IMPRESSED CURRENT ❑ 6.ISOLATION 148. IX. APPLICANT SIGNATURE CERTIFICATION:I certify that tbitUST system h compatible with the hazardous substance stored and that the information provided herein is _te, and In full eo al ul--Rts. 1' APPLICANT SIGNATURE DATE 5 Z(?O $ APPLICANT NAME(print) ( 3 { (� f} T 1 (v APPLICANT TITLE f ©UD n f 472. t. UPCF UST-B-1/2 Rev.(12/2007);