INSTALL_2008 - Laserfiche WebLink

Home Browse Search

From 11(03/2008 15:36 #164 P 0161033 N7ED PROGRAM CONSOLIDATED FL. Al UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION--TANK INFORMATION(One form per USTNow on M ) TYPE OF ACTION (Check one item only. For an UST permanent closure or rWrloval,cotnplete only this section and Sections I,11,111,IV,and IX below) a3o �I NEW PP.RMIT � 3.RENEWAL PERMIT Q 5.CHANGE pF INFORMATION Q 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE pN SiTE S.US7 REMOVAL DATE UST PERMANENTLY CLOSED: 4304 DATE$X[STING UST D1SCC+VERgD: 430b L FACILITY INFORMATION ��02 � FACILITY ID#(�igency(Ise Only) � � BUSINESS NAME(Same as FACI 11Y NAME or DBA-Doing Business As) d 3 BUSINESS SITE ADDRESS 103 CITY 104 II.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 .A STAND-ALONE TANK 2.ONE INA COMPARTMENTED UNIT complete one Me for ch Mt in the unit DATE UST SYSTEM INSTALLED 435 TANK CAPACITY M GALLONS 435 NUMBER OF COMPARTMENTS IN THE UNIT 437 III.TANK USE AND CONTENTS TANK USE la MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ IC.AVIATION FUELING 439 ❑3.CHEMICAL PRODUCT STORAGE Q 4.HAZARDOUS WASTE(inetudes 1lsedoil) ❑5.EMERGENCY GENERATOR FUEL(HSC§23281 s(e)I ❑ 6.OTHER GENERATOR FUEL ❑95.UNKNOWN ❑ 99.OTHER (Specify): 4394 CONTENTS PETROLEUM: 19 is.REGULAR UNLEADED CS ❑ lo.MIDGRADE UNLEADED {] lb.PREMIUM UNLEADED J440❑3.DIESEL ❑ S.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL [ 9.OTHER PETROLEUM (S eif NON-PETROLEUM:❑ 7.USED OIL 10.ETHANOL ❑ 11.OTHERNON-PETROLEUM ecif):IV. TANK CONSTRUCTION TYPEOFTANK 1.SINGLE WALL 2.DOUBLE WALL 95.UNKNOWN 4 PRIMARY CONTAINMENT 1.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (Speci 4448 SECONDARY CONTAINMENT 0 1 STEEL 3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 443 90_NONE ❑95.UNKNOWN [399* TUBEOTHER(S 'f)I 4434 OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALL FLSHUT-OFF VALVE 452 ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION. 0 I.SINGLE-WALLED 2.DOUBLE-WALLED Q 99.Q71TR 1464c SYSTEM TYPE 1.PRESSURE ❑2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION 23 CCR¢2636(4x3)) PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE 10.RIGID PLASTIC ❑ 90.NONE ❑95.UNKNOWN ❑ 99.OTHER(Specify): SECONDARY CONTAINMENT ❑ 1 STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC ❑ 90.NONE [193.UNKNOWN ❑ 99.OTHER(Specify): PIPINGn URBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 90.NONE 4Md VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENTPMMARY CONTAINMENT 1.STEE 15 4.FIBERGLASS 0 10.RIGID PLASTIC 040.NONE 99 ,OTHER(specify) 4648 46481 VENT SECONDARY CONTAINMENT D I.STEEL 4.FIBERGLASS 0 10.RIGIDPLASTIC V.NONE ❑99,OTHER(Specify) 464f 464!1 VR PRIMARY CONTAINMENT 1 STEEL 10 4.FIBERGLASS 0 10.RIGID PLASTIC 90.NONE Lj 99.OTHER(Specify) 4645 aha r VIZ SECONDARY CONTAINMENT I.STEEL, 4.FIBERGLASS ❑ I0.RIGID PLAST)C ❑ 90.NONE ❑ 99.OTHER(Specify) 464h VENT PIPING TRANSITION SUMP TYPE 1,SINGLE WALL 2.DOUBLE WALL [1:3190,NONE 4644; RISER PRIMARY CONTAINMENT ❑ 1.STEEL IN 4.FIBERGLASS ❑ I Q.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464j RISER SECONDARY CONTAINMENT ❑ 1.STEEL 19 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 9D.NONE 94.OTHER(Specify) g6 I FILL COMPONENTS INSTALLED 1.SPILL BUCKET ❑ 3.STRfKER PLATE/BOTTOM PREC OTTOR V 47 464k1 CONTAINMENT SUMP 45ta•c VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469, CONSTRUCTION MATERIAL I.STEEL 4.FIBERGLASS 10.RIGID PLASTIC ❑99.OTHER(Swif) 469 c VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT J�6.ISOLATION aas 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 In full compliance with legal reQukements. APPLICANT SIGNATURE JDATE 470 APPLICANT NAME(print) :aHAPPLICANT TITLE 47z