BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

G. At- .,tFIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK F OPERATING PERMIT APPLICATION-TANK INFORMATIO pe 1s TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections i,11, below 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFO El-6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL �F+Q DATF.UST PERMANENTLY CLOSED: 430a DATE EXISTING UST DISCOVERED: tp 4306 I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ I BUSINESS NAME(Same as FACILITY AME or,DBA-Doing Business As) 3 Ef4%t�S �I uwlic rt "- }�o U INE SITqAD R la3 y ,a rYl a, CC)-tCYN `t 53ac) H.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 390oaa31 4S5asob(oRg - � ❑LASTAND-ALONE TANK TruscO a2.ONE MACOMPARTMENTED UNIT. Com let.one pionesu eaN MPMeNed in the unit. DATE UST SYSTEM INSTAL D 435 TANK CIITYY N LONS 436 NUMB OF COMPARTMENTS IN THE UNIT 437 III TANKUS9 AND CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ 16.MARINA FUELING ❑ le.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(IrKIoAn Ure6 oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25231.5(.)] ❑ 6.OTHER GEN ATOR FUEL Q 95.UNKNOWN ❑ 99.OTHER (Specify): 439. CONTENTS PETROLEUM: 1s. GULAR UNLEAD - Eric.MIDGRADE UNLEADED 446 '3.DIF.SIE, ❑ 5.JET FUEL. ❑ 6.AVIATION GAS ❑ S.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 44a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11,OTHER NON-PETROLEUM S eci : 44°6 IV. TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL '2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ❑ 1.STEEL Rk 3.FIBERGLASS El 6.INIERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99,OTHER (Specify): 444e SECONDARY CONTAINMENT ❑ 1.STEEL M3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7 JACKETED 445 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.GTHER(S i a45. OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS 2.BALL PLOAT 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑I.SINGLE-WALLED CP.DOUBLE-WALLED ❑99.OTHER 460 SYSTEM TYPE ❑ L PRESSURE ❑ 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2W6(,)J 458 . PRIMARY CONTAINMENT ❑ 1.STEEL [X 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464. SECONDARY CONTAINMENT ❑ I.STEEL PK 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 4646 [290.NONE El 95.UNKNOWN ❑ 99.OTHER(Specify): 464. PIPMG,TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE a64d VI.VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464. 4WI VENT SECONDARY CONTAINMENT L STEEL [14.FIBERGLASS El10.RIGID PLASTIC [390.NONE [199.OTHER(Specify) 4641' II 464Fl I VR PRIMARY CONTAINMENT 1,STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHM(Specify) 464¢ VR SECONDARY CONTAINMENT I STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE 0 99.OTHER(Specify) 464h 464hl VENT PIPING TRANSITION SUMP TYPE ❑ L SINGLEWALL 2.DOUBLE WALL 90.NONE 464i. RISER PRIMARY CONTAINMENT L11.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify) 464, 464'i RISER SECONDARY CONTAINMENT 0 L STEM V4.PIBERGLASS 0 10.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify) 464k 464kl FILL COMPONENTS INSTALLED ❑ 1.SPILL BUCKET ❑ 3.STRIKER PLATEMOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 451.-. VII.UNDER DISPENSER CONTAINMENT(UDQ CONSTRUCTION TYPE ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469. CONSTRUCTION MATERIAL ❑ L STEEL K4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 4696. VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANObE(S) ❑ 4.IMPRESSED CURRENT ❑ 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this USTs sMla nn m mpatfble with the hazardous substance stored and that the information provided herein is true,accurate, in full co ion 1 al requirements. j PLI T DATE 4M, lo PLIC E 471' APPLICANT TITLE ! n1 4n na, UPCF UST-B 1/2 tM Rev.(12/2007)