BILLING PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (Mo pages per tank) �// P.Q. L of TYPE OF ACTION lS 1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check one Ram only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑3 RENEWAL PERMIT (Specify Mason-for total use Only) (Spocey change-for local use only) ❑ 6 TANK REMOVED 430 O1 BUSINESS NAME(Same as FACILITY NAME a OBA.Oo.ng Bufu+ess As) FACILITY 10 0 1 L ov a3 5, 1 � I tl LOCATION WITHIN SITE(Opoon&O 431 1.TANK DESCRIPTION TANK IO a TANK MANUUF.A_CTURER TT COMPARTMENTALIZED TANK ❑ Vef No Mod t.", wdck k Co. O t T-4 rat iMC. If Yef',cdmplHfor e dna page eaU rampartm me DATE IN TA ED O) TANK CAPACITY IN GALLON$ NUMBER OF COMPARTMENTS U 0%� �11� ADDITIONAL DESCRIPTION(ForloCal use only) 11.TANK CONTENTS // lk9 TANK USE 412 � / PETROLEUM TYPE ,�, LAS t MOTOR VEHICLE FUEL 7a/ REGULAR UNLEADED ❑ 2. LEADED ❑ 5 JET FUEL (rt marked.complete Peholeum Type) ❑10 PREMIUM UNLEADED ❑ 3 DIESEL ❑ 6 AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑1C MIOGRAOE UNLEAOEO ❑ 4 GASOHOL ❑99 OTHER ❑ 3 CHEMICAL PRODUCT CAS 0(!mm H4Z8MC-s Mate"S tRwIdory page) COMMON NAME(hom rHa'zardous MDafsna_lss 1mwnr`uy Page) ❑ 4 HAZARDOUS WASTE(Includes Used 01, Qy V1, III.TANK CONSTRUCTION TYPE OF TANK ❑ 1 SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5 SINGLE WALL WITH INTERNAL BLADDER SYSTEM EXTERIOR MEMBRANE LINER ❑95 UNKNOWN (Crack ane Mm only) L}{�. pOUBLE WALL ❑ 4 SINGLE WALL IN A VAULT (k `4f „1 ❑99 OTHER TANK MATERIAL-pnmary tank 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5 CONCRETE ❑95. UNKNOWN (Check one Rem only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WMBERGLASS ❑ 6 FRP COMPATIBLE W1100%METHANOL ❑99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank ❑ 1 BARE STEEL [3 33 FIBERGLASS I PLASTIC ❑ 6. FRP COMPATIBLE WI100%METHANOL ❑95. UNKNOWN (Check one Ram only) ❑ 2. STAINLESS STEEL LY 4, STEEL CLAD W/FIBERGLASS ❑ 9 FRP NON-CORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ 5 CONCRETE DATE INSTALLED TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING C1S jsLASS LINING ❑95. UNKNOWN433 OR COATING ,Ls7,/ ❑ 2. ALKYD LINING ❑ 1 PHENOLIC LINING 6 UNLINED C3 99. OTHER (For local use ) (Check one dem on ) OATE INSTALLED OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 434 PROTECTION IF APPLICABLE PROTECTION ❑ 1 IMPRESSED/CUR ENT ❑99 OTHER (For local use only) (Check one Rem only) I�1 2 SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocal sa only) OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED (Check as that apply) SPILL CONTAINMENT ALARM ^0 ❑ 3 FILL TUBE SHUT OFF VALVE L�!'�2. DROP TUBE LY 2. BALL FLOAT Z 6y ❑ 4 EXEMPT LY 3. STRIKER PLATE N. TANK LEAK DETECTION IF DOUBLE WALT TANK OR TANK WITH BLADDER one Mm IF SINGLE WALL TANK(Ctack am 11741 apply). ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5, MANUAL TANK GAUGING(MTG) ❑ 11/VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE tis 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 6. TANK TESTING BIENNIAL TANK TESTING ❑99 OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MOIOAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED VIATH INERT MATERIAL? gallons ❑Yam ❑NO c� I2Ijok L� �ol�l6v Formerty SWRCB Form B CUPAFORM(4/99) ( � g/ / ori la1(()