COMPLIANCE INFO_2009-2011 - Laserfiche WebLink

Home Browse Search

UNIkIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (one funn per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal, complete only this section and Sections /, /I, III, 1v and IX beton) - 436 ❑ 1. NEW PERMIT 0 3. RENEWAL PERMIT rl 5. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE F1 7, UST PERMANENT rl nQ1 IRE I _�ffsw V M� nM err= M o "CDv A^%,. , DATE UST PERMANENTLY CLOSED: DATE EXISTING UST DISCOVERED: 430b, I. FACILITY INFORMATION FACILITY ID # (Agenqv, Use Only) 1. BUSINESS NAME (Same as Facility Name or DRel - Doing Rushiers As) 1 FLYING J TRAVEL PLAZA BUSINESS SITE ADDRESS 103. CITY 104. 1501 NORTH JACK TONE ROAD I RIPON H. TkNKDESCMPTION TANK ID # 432. TANK MANUFACTURER 433. TANK FIGURATION: THIS TANK IS 434. 2 OWENS CORNING 0 1, A STAND-ALONE TANK Complete one page foreach - D 2. ONE IN A COMPARTMENTED UNIT cmpanmem in the unit: DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 430. NUMBER OF COMPARTMENTS IN THE UNIT 437. 12/1994 20,000 M. TANK USE AND CONTENTS TANK USE 0 Ia. MOTOR VEHICLE FUELING ❑ lb, MARINA FUELING 0 lc. AVIATION FUELING439. 0 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (inciudes used oil) [35. EMERGENCY GENER;ATOR FUEL[115C §2s2si.5(c)l -_ -' 11 6. OTHER GENERATOR FUEL 95. UNKNOWN 0 99, OTHER (Specify): 4398. EO-NTENTS PETROLEUM- [3 Ia REGULAR iTNLiW6j6_tj -1c. MIDGRADE UNLEADED El 1b, PREMIUM UNLEADED -74-0 0 3. DIESEL 0 5. JET FUEL D 6. AVIATION OAS D 8. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (Specify): 4408. NON-PETROLEiTm, 0 7.* USED OIL 10•ETHANOL- ----- ❑ 1. OTHER NON -PETROLEUM (Specify): 4406. IV. TANK CONSTRUCTION TYPE OFTANK ❑ I. SINGLE WALL M 1DOUBLE WALL 0 93. UNKNOWN -STEEL '-'- 443. PRIMARY CONTAINMENT ❑ 1. _C93. FIBERGLASS 0 6. INTERNAL BLADDER _444'_ ❑ 7. STEEL+ INTERNAL LINING 1195. UNKNOWN 0 99. OTHER (Specify): 444a, _ --'-'❑----- SECONDARY -CONTAINMEN--T0 F ®3. FIBERGLASS 0 6. EXTERIOR MEMBRANE LINER ff -- 4_5"' 7. JACKETED-- 0 90, NONE 11 95- UNKNOWN ❑ 99. OTHER (Specify): 445m, OVERFILL PREVENTION 0 1, AUDIBLE & VISUAL ALARMS [3 2. BALL FLOAT 0 3. FILL TUBE SHUT-OFF VALVE 452, 0 4. TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION WUIPMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION LJ 1. SINGLE WALL 21 2. DOUBLE WALL ff 99. OTHER -b-2.-GRA-VIT-Y 460. SYSTEM TYPE 1, PRESSURE '__0 3. CONVENTIONAL SUCTION [1 4. SAFE SUCTION [23 CCR §2636(.)(1)] PRIMARY CONTAINMENT 0 1. STEEL 10 4, FIBERGLASS 458. 0 8, FLEXIBLE 0 10. RIGID PLASTIC 90. NONE El 25, UNKNOWN El 99. OTHER (Specify); 464. 4648. SECONDARY CONTAINMENT Ll 1. STEEL 4. FIBERGLASS ❑ 8. FLEXIBLE (3 10. RIGID PLASTIC 4648, M 40. NONE95. UNKNOWN 0 _99. OTHER (Specify): 464c. PIPING/TURBINE CONTAINMENT SUMP TYPE 1; SINGLE WALL 0 2. DOUBLE WALL 0 90. NONE ~y 464d. V1. VENT, VAPOR RECOVERY ") A" RISER / FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1, STEEL 8 4. FIBERGLASS 0 10. RIGID PLASTIC 11 90.NONE 0 99. OTHER (Specify): 464.7 VENT SECONDARY CONTAINMENT [1 L. STEEL 0 4. FIBERGLASS 0 10. RIGID PLASTICf. 0 9D� NONE ❑[3 99. OTHER (Specify): _FlB&6LASS 464d. 464464fl. VR PRIMARY CONTAINMENT 0 L STEEL W �. 11 10. RIGID PLASTIC [1 90. NONE 11 99, OTHER (Specify)- 4 VR SECONDARY CONTAINMENT [3 1. STEEL 4, FIBERGLASS 0 10. RIGID PLASTIC [3 90. NONE E3 OTHER (Specify); cify): 4611. - 464 -99. VENT PIPING TRANSITION SUMP TYPE TSIN�LE WALL 0 2. DOUBLE WALL [3 90. NONE 4601, 464i RISER PRIMARY CONTAINMENT 0 LSTEEL 0 4. FIBERGLASS 0 10. RIGID PLASTIC [190.;ONE�O�99.1-:;THER(Sincify): RISER SECONDARY CONTAINMENT ❑0 LSTEEL 0 4. FIBERGLASS [) -10. _RIGID PLASTIC------ [1 90, NONE ❑El 99. OTHER (Specify): 464j]. 464k. FILL COMPONENTS_ 'ILL BUCKE��IKFR PLATE/BOTTOM PROTECTOR r J4_'._CONTAINMENT SUMP 464kI. V11. UNDER DISPENSER CONTAINMENT "C) CONSTRUCTION TYPE 19 I.S INGLE WA 2. DOUBLE WALL Q 3. NO DISPENSERS 90. NONE 46%. CONSTRUCTION MATERIAL ❑ 1. STEEL 0 4, FIBE'GLASS 0 10. _RtGlD ❑PLASTIC 0 99. OTHER (Specify)____"_-_' 40i6.' VM. CORROSION PROTECTION 469c, STEEL COMPONENT PROTECTION 0 2. SACRIFICIAL -ANODE(S) D 4. IMPRESSED CURRENT El 6. ISOLATION 448. IX APPLICANT SIGNATURE CERTIFICATION. I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate, and hn, fulfl, Bianca with " u' rc�quircments. �Com �Ienfl APPLICANT SIGNATURE DATE 09/18/2008 410. APPLICANT NAME (print) JEFF LARSEN 471. APPLICANTTITLE DIRECTOR OF HSaE 472, UPCF UST -B Rev. (12/2007) - 1/2 www.unidoes.org