BILLING 1985 - 2007 - Laserfiche WebLink

Home Browse Search

0 0 UNIFIED PROGRAM TANKS O CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - TANK PAGE 1 'F67 ,2136D (Two pages per tank) TYPE OF ACTION Page L of�- I.NEW PERMIT ❑ 4.AMENDED PERMIT ❑ 5,CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one item only) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED B INE S N E(Same es FACILITY NAME or DBA-Doing mess 3. FACILITY ID: I. LOCATI WITHIN SITE(Optional) 431. I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 2. TANK MAN FACTURER 433. COMPARTMENTALIZED TANK Yes ❑ No 434. '�) r // .5 M v� F- If"Yes,"complete one page for each compartment. DATE INSTALLED 5• TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS (YEAR/MO) r i '7 � 0� 437. ADDITIONAL DESCRIPTION(For local use only) 9. 438. II.TANK CONTENTS TAI K USE 439. POLEUM TYPE I. MOTOR VEHICLE FUEL 440. Ia. REGULAR UNLEADED ❑2 LEADED ❑5. JET FUEL (Ifchecked,complete Petroleum Type) PREMIUM UNLEADED (73. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 [1 4. HAZARDOUS WASTE CAS#(from HInventory azardous Materials Invento 442. (Includes Used Oil) ❑ 95.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑1. SINGLE WALL ❑3. SINGLE WALL WITH EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. (Check one item only) ,f� MEMBRANE LINER ❑95. UNKNOWN Lr! DOUBLE WALL M 4. SINGLE WALL IN A VAULT ❑99. OTHER TANK MATERIAL-primary tank I. BARE STEEL FIBERGLASS/PLASTIC El5. CONCRETE ❑95.UNKNOWN 444. (Check one item only) ❑2. STAINLESS STEEL STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE _ ❑99.OTHER: REINFORCED PLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary tank ❑1. BARE STEEL V3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL ❑95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL 14. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING ❑�,GLASS LINING El95.UNKNOWN 446DA . TE INSTALLED 447. OR COATING El2.ALKYD LINING ❑4.PHENOLIC LINING 6.UNLINED ❑99.OTHER Check one item only) OTHER CORROSION ❑I.MANUFACTURED CATHODICLI J.FIBERGLASS REINFORCED PLASTIC ❑95.UNKNOWN 448. DATE INSTALLED 449, PROTECTION PROTECTION ❑4.IMPRESSED CURRENT If A licable ❑2.SACRIFICIAL ANODE 1:199.OTHER SPILL AND OVERFILL - YEAR INSTALLED 450. E t,�/ 45I. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) SPILL CONTAINMENT 1.ALARM .DROP TUBE 11 _ ❑3.FILL TUBE SHUT OFF VALVE STRIKER PLATE /� t t )f 2.BALL FLOAT_ ❑4.EXEMPT . IV.TANK LEAK DETECTION (A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK (Check all that apply) 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check one item only) d❑1. VISUAL(EXPOSED PORTION ONLY) ❑5.MANUAL TANK GAUGING(MTG) ❑I.VISUAL(SINGLE WALL IN VAULT ONLY) 2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE i�,2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING ❑4.STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457. gallons ❑Yes ❑ No UPCF hwfwrc-b(1/99)-1/4 www.unidoes.org Rev.02/16/00