BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FOR._ TANKS FUNDERGROUND STORAGE TANKS-TANK P &- I 7 (two pages per tank) LPage _ of _ ❑ 8.TEMPORARY SITE CLOSURE TYPE OF ACTION �.NEW SITE PERMIT- ❑ 4.AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 7 PERMANENTLY CLOSED ON SITE (Check one item only) [13.RENEWAL PERMIT (S,.dy reason-for local use only) (Spealy change-/or local use only) ❑ 8. TANK REMOVED 430 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY IDA H= o L! LOCATION WITHIN SITE(Option/) 431 I.TANK DESCRIPTION TANK MANUFACTURER COMPARTMENTALIZED TANK 'Yes ❑ No TANK 10 A /J, 7'///a`'5 If-Yes',complete one page for each compartment. .fNK4 f /�` /� �"�� NUMBER OF COMPARTMENTS DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS 13 l a L� I Z, 00C.) ADDITION A DESCRIPTION(Forlocal use only) II.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 5. JET FUEL Cr REGULAR UNLEADED ❑ 2. LEADED 1. MOTOR VEHICLE FUEL ❑ 3. DIESEL ❑ 6.AVIATION FUEL (1 marked,complete petroleum Type) ❑ty, PREMIUM UNLEADED [199. OTHER ❑ 2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ CASA(lrom Hazardous Materials Inventory page) 3. CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE(Inducies Used Oil) 95 Ill.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM �y EXTERIOR MEMBRANE LINER ❑95. UNKNOWN (Check one item only) 2. DOUBLE WALL ❑ q, SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL•primary tank J. BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN B. FRP COMPATIBLE W/100%METHANOL 99. OTHER (Check one item only) 2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑ ❑ REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank ❑ 1 BARE STEEL 93. FIBERGLASS/PLASTIC ❑ a. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 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 ❑ 5. GLASS LINING ❑95. UNKNOWN433 OR COATING ❑ 4, PHENOLIC LINING O.6. UNLINED ❑99.OTHER (Forlocal use only) ❑ 2.ALKYD LINING DATE INSTALLED (Check one item only) OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC Y'�_ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 PROTECTION IF APPLICABLE PROTECTION LiLi--JJ�� 4. IMPRESSED CURRENT ❑99. OTHER (For local use only) (Check one item only) ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocal use only) (Check all that apply) 1. SPILL CONTAINMENT Z�L rn L n�� 1.ALARM � ❑ 3. FILL TUBE SHUT OFF VALVE D ` -7 2. DROP TUBE op fl 2. BALL FLOAT U C34. EXEMPT 3. STRIKER PLATE +- _ IV.TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER Check one item only): IF SINGLE WALL TANK Check all that a ): ❑ S. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)r ❑ 8. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YRlMOIDAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED WITH INERT MATERIAL? gallons ❑Yes ❑No Formerly SWRCB Form B CUPAFORM(4/99)