BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

6 L- .FIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only Foran UST permanent closure or removal,complete only this section and Sections I,1I,IN,IV,and IX below) 430 ❑ 1 NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ T UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 410e I DATE EXISTING UST DISCOVERED: 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ I i,USIN SS NAME( ame as FACILITY N F D��A-Doin B Fs 19� 3 ©l2-. U ESS TE ESS 1N --- l04 MY1 1 Ca.- 91) II.TANK DESCRIPTION TANK IID; #+� 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 El I rte[ C� ❑2.ONE NA'CALONE NTED UNR, / vl Canletemw fm eaM com artmem in theieit DATE UST SYSTEM INSTAL D_ 435 TANK C I03�5� 436 NUMBE�QOF COMPARTMENTS IN THE UNIT 437 III.TANK USE AND CONTENTS TANK USE MI&MOTOR VEHICLE FUELING [3 1b.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ind.d..Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC¢25281.5(0)] ❑ 6.OTHER GENERATOR FUEL ❑ 95. OWN 9 ri 4398 CONTENTS PETROLEUM: 1yla.REGULAR UNLEADED Ic.MTDGRADE UNLEADED 410 3.DIESEL ❑ S.M7 FUEL U 6.AVIATION GAS 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Speedy); 440. NON-PETROLEUM:❑ T USED OIL ❑ METHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 4406 IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2,DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL $53.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 2STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑791 MR S ri 441. SECONDARY CONTAINMENT ❑ 1.STEEL W.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.3ACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN [199 OTHER(Sify: 44U OVERFILL PREVENTION ❑ I.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑L SINGLE-WALLED M< DOUBLE-WALLED [199.OTHER 460 SYSTEM TYPE ❑ I.PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION(23 CCR 2636(.) 458 PRIMARY CONTAINMENT ❑ I STEEL 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spwify): 4648 SECONDARY CONTAINMENT ❑ 1.STEEL EJ:4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ I.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT L STEEI. ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE 99.OTHER(Specify) 4648 464.1 VENT SECONDARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTIJER(Specify) 464f 464n VR PRIMARY CONTAINMENT 1.STEEI. D 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE C3 99,OTHER(Specify) 4648 469 1 VR SECONDARY CONTAINMENT I STEEL 4.FIBERGLASS El 10.RIGID PLASTIC 0 90.NONE 0 99.OTHER(Specify) 464h M01 VENT PIPING TRANSITION SUMP TYPE ❑ 1.SINGLE.WALL2.DOUBLE WALL 90.NONE 464E RISER PRIMARY CONTAINMENT ❑ I.S'IBEL 4.FIBERGLASS El 10,RIGID PLASTIC LJ 90.NONE ❑ 99.OTHER(SPC4YfY) 4641 464'1 RISER SECONDARY CONTAINMENT L STEEL INFIBERGLASS ❑ 10.RIGID PLASTIC 0 90.NONE 99.OTHER(Specify) a64k 46411 FILL COMPONENTS INSTALLED L SPILL BUCKET ❑ 3.STRIKER PLATE/BOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451rc VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469e CONSTRUCTION MATERIAL ❑ 1.STEEL IL4.FIBERGLASS ❑ I0.RIGID PLASTIC ❑ 99.OTHER(Specify) 469bc VIIL CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 446, IX. AP ICANT SIGNATURE CERTIFICATION: I certify that t ' UST;p is compatible hazardous substance stored and that the information provided herein is true,accurate, and in f om II ce i 1 el re ftC-- APPLICANT SIGNATURee/ TE 400- APPLICANT NA " (� 1' APPLICANT TITLE o-(')D 4n UPCF UST-B 1/2 Rev.(12/2007)