BILLING PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS I� UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages Ur ta-,; Page -? of /o TYPE OF ACTION 1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check one dem only) ❑ 7 PERMANENTLY CLOSED ON SITE Cl 3 RENEWAL PERMIT (Sp«M reason.for local use only) (Sp.ary change-for local use only) ❑ 6 TANK REMOVED 430 l BUSINESS NAME(Same as FACILITY NAME or C8A-Doug Busuwss As) FACILITY 10 0 1 L ov�3 C( , ,J,v S6yR LOCATION WITHIN SITE(OpoonM I e 431 1.TANK DESCRIPTION TANK ID 0 NK MANUFACTURER J 1" 1(� a COMPARTMENTALIZED TANK C1 Yes Na r / /0 G c1r l� Ui R �U �V I "C S r��. If'Yai.Complete one page tot each companmert DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS A004TIONAL DESCRIPTION(For local use only) II.TANK CONTENTS ,..(/ TANK USE 432 PETROLEUM TYPE MOTOR VEHICLE FUEL C3 1. REGULAR UNLEADED ❑ 2. LEADED C1 5 JET FUEL (!f marked,complete Petroleum Type) C1L"1 iC PREMIUM UNLEADED 3. DIESEL ❑ 6 AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑is MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99 OTHER ❑ 3 CHEMICAL PRODUCT CAS 0(from HaiJldous Mafenala Inventory page) COMMON NAME(hom Haiardoua Malehala Inventory page) ❑ 4 HAZARDOUS WASTE(Includes Used W III.TANK CONSTRUCTION TYPE OF TANK DC1OUBLE WALL INGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5 SINGLE WALL WITH INTERNAL BLADDER SYSTEM fUO// EXTERIOR MEMBRANE LINER 95 UNKNOWN (Check one,dem only) 2 D ❑ 4 SINGLE WALL IN A VAULT �I�j -,lI B: ❑99 OTHER TANK MATERIAL-primary tank 1. BARE STEEL�Wl 11 ❑ 3. FIBERGLASS/PLASTIC ❑ S CONCRETE C3 95. UNKNOWN (Crock one dem only) ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑ 6 FRP COMPATIBLE W/100%METHANOL ❑99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary Ian' ❑ 1 BARE STEEL ❑ 33 ISERGLASS/PLASTIC C36 FRP COMPATIBLE WI100%METHANOL C]95. UNKNOWN (Check one dem only) ❑ Z. STAINLESS STEEL LJ 4- STEEL CLAD WIFIBERGLASS ❑ 9 FRP NON-CORROOIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) ❑10 COATED STEEL ❑ 5 CONCRETE DATE INSTALLED TANK INTERIOR LINING ❑ 1. RUBBER LINED C13. EPDXY LINING ❑ 5 SS LINING C395. UNKNOWN433 OR COATING ❑ 2. ALKYD LINING ❑ 4 PHENOLIC LINING 6 UNLINED ❑99. OTHER (for local use on ! (Check one dem on ) DATE INSTALLED OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 434 PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99 OTHER (For bCa/uae only) (Check one dem only) ❑ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only) OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED (Check a0 that apply) t SPILL CONTAINMENT O 11 ALARM ❑ 3 FILL TUBE SHUT OFF VALVE ,�,�2. DROP TUBE 2 o a 2. BALL FLOAT 0�❑ 4 EXEMPT Ly 3. STRIKER PLATE O O N.TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one dem 1 IF SINGLE WALL TANK Crock a that ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGING(MTG) - ❑ 1/VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ S. VAOOSE ZONE 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNOWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)♦ ❑ S. TANK TESTING BIENNIAL TANK TESTING ❑99, OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MOIOAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL] gallons ❑yes ❑No g ,TO L4- Formerly SWRCS Form B CUPAFORM(4/99)