BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

PAAA IF Ar UPCF UST -B Rev. (12/2007) -1/2 www.unidocs.org r FIED PROGRAM CONSOLIDATED FOIVrl( UNDERGROUNDSTORAGETANK t OPERATING PERMIT APPLICATION -TANK INFORMATION (One form / 2s l TYPE OF ACTION (Check one item only. Fora UST closure or removal, complete only this secdon and Sections 1, 11, Ill, 1V and INbelow) 430. ❑ L NEW PERMIT 1. RENEWAL PERMIT [:15. CHANGE OF INFORMATION 6. TEMPORARY UST CLOSURE 7. UST PERMANENT CLOSURE ON SITE8. UST REMOVAL DATE UST PERMANENTLY CLOSED: 430.. DATE EXISTING UST DISCOVERED: 4306. I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ _ 7/9 1.t BUSINESS NAME (Sr A7cIhty Name r A�Ul oiag Busi s As) 4/ 'G / 3 BUSIN SS AD RESS / tN, A CITY SG / /� !l T IN. H. TANK DESCRIPTION TANK ID # O6-� O a3z T�A1I-��NK MANUFACTURER iJ3 /�rliil'/l►t /it}'i0�%j TANK CONFIGURATION: THIS TANK IS +34 Art.PIM ama.PWme�e�'n«h 2.Ot STANDALONE ETAN�NrED l.✓r UNIT = DATE UST SYSi INSTALLED 435• r,I4 �`� z4�4 TANK CAPACITY IN GALLONS 036. 20A,� NUMBER OF COMPARTMENTS IN THE UNIT 47. oyi III. TANK USE AND CONTENTS TANK USE a MOTOR VEHICLE FUELING [3 Ib. MARINA FUELING ❑ lc. AVIATION FUELING 439. 7. CHEMICAL PRODUCT STORAGE (3 4. HAZARDOUS WASTE gnclW Uwe Oil) ❑ 5. EMERGENCY GENERATOR FUEL [HSC I2525I.5(c)) _ 136.OTHER GENERATOR FUEL [395. UNKNOWN _ ❑ 99. OTHER (Specify): 439a _ _ _ CONTENTS PETROLEUM: [3la. REGULAR UNLEADED 13Ic. MIDGRADE UNLEADED �W b. PREMIUM UNLEADED aw. ❑ 3. DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ___ _ [3$.PETROLEUM BLEND FUEL _❑ 9. OTHER PE77ROLEUM(C�j:. NON -PETROLEUM: ❑ US Z ED OIL ❑ l0. ETHANOL ❑ 11. OTHER NON -PETROLEUMS 4406. IV. TANK CONSTRUCTION _TYPE OF TANK __.____[3 1. SINGLE WALL GF -3. DOUBLE WALL 495. UNKNOWN 413, PRIMARY CONTAINMENT ❑ 1. STEEL 3. FIBERGLASS❑ 6. INTERNAL BLADDER---_--�----_---- 4a. ❑ 7. STEEL + INTERNAL LINING ❑ 95. UNKNOWN ❑ 99.OTHER (Specify): 444x. SECONDARY CONTAINMENT ❑ 1. STEEL FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED uf. ❑ 90. NONE [j 95. UNKNOWN 99. OTHER (Specify): -0 OVERFILL PREVENTION . AUDIBLE & VISUAL ALARMS M3 2. BALL FLOAT E33. FILL TUBE SHUT-OFF VALVE 452. 4. TANK MEETS RE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUWMENT V. PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1. SINGLE WALL 2n. DOUBLE WALL O 99. OTHER 46a SYSTEM TYPE __x I. PRESSURE _[J 2. GRAVITY _- ❑ 3. CONVENTIONAL SUCTION 4. SAFE SUCTION_v CCR 4�636G)(3H 458- _.._ PRIMARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS X&FLEXIBLE ❑ 10. RIGID PLASTIC 4+. E3 90. NONE _ (3 95. UNKNOWN .......___.. 99.OTHER(SPeci t 4600 SECONDARY CONTAINMENT [31. STEEL ❑ 4. FIBERGLASS FLEX®LE ice• ❑ io.RIGiOPLASTIC 464b. _ __ ____ ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99_OTHER(Speci 4eoc. PIPING(TURB(NE CONTAINMENT SUMP TYPE 1%4. SINGLE WALL 2. DOUBLE WALL 90. NONE 0604 VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ 1. STEEL 'SC4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER _ (Specify): VENT SECONDARY CONTAINMENT ❑ 1. STEEL M4 _FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify): ____ ..__. __.I __.__.______.__-____.._..___ 4�0. VR PRI MARY CONTAINMENT ❑ 1. STEEL . FlBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Sperify): 464Q. VR SECONDARY CONTAINMENT ❑ L STEEL 4. FIBERGLASS ❑ 10. RIGIDPLAS'T'IC ❑ 90._NONE ❑ 99. OTHER (Specify): VENT PIPING TRANSITION SUMP TYPE}❑.r I. SINGLE WALL ❑ 2. DOUBLE WALL_ Ele90. NONE RISER PRIMARY CONTAINMENT❑ 1. STEEL T44. FIBEiRGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER ($pacify): de4r. 460 RISER SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC R O. NONE ❑ 99. OTHER (Specify): FILL COMPONENTS 3R2. SPILL BUCKET 3jt3. STRIKER PLATUBOTTOM PROTECTOR 3NE. CONTAINMENT SUMP 451a VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE I. SINGLE WALL_ [32_DOUBLE_WALL 4 3. NO DISPENSERS 490. NONE +� _ CONSTRUCTION MATERIAL C11. STEEL ❑ 4. FIBERGLASS 10. RIGID PLASTIC ❑ 99. OTHER (Specify)' VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. I.4PRESSED CURRENT 6. ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: 1 certify that this UST system is compatible with the hazardous substance stored and that the information provided herein Is true, accur om liaucew irem s. APPLICANT SIGNATURE DATE O6 4M. APPLICANT NAME (print) 00 °71' APPLICANT TITLE ,G,e 472. IF Ar UPCF UST -B Rev. (12/2007) -1/2 www.unidocs.org