COMPLIANCE INFO 1998-2003 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS- TANK.PAGE l TANKS (two pages per tank) TYPF.OF AL"11ON ❑1 NEW SITE PERMIT ]'age� of 2- D 4 AMENDED PERtt911' ® 5 CHANGE OF iNl'ORMA'1']ON ❑ 6 TEMPORARYSI'r]?CLOSURE (t:heek one nem telt) �,_.�_� ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEMAL PERMIT (Specify reason-for local use only) (5Peciiy reason for]peal use anly) ❑ 8 TANK REMOVED 430 BUStNI:SS NAME(Same as FACILITY NAME or DBA-Dotng nusmcss As) FACILTI Y ID: E.F. KLUDT&SONS INC, 3 F A` 0 0 0 3 7 7 1 I LOCATION WIT}LIN SITE(optional) at cornet' 431 L TANK DESCRIPTION (A scaled plot plan with the locniion oCthe U3T system including buildings and landmarks shall be submitted to Ute local agency.) TANK LT)9 432 TANK MANUF AU I URLR 433 COMPARTMENTALIZED TANK ❑Yes ® No 434 7-UG TR USCG if"Yes",complete one page for each cnmpartrnem DATE'INSTALLED-(-YEAR/M0) 435 TANK CAPACITY IN GALLONS 436 NUMBER 017 COMPARTMENTS 437 1989/ Dec. 10,000 one ADDITIONAL DESCRIpT'ION(Far Lora,use only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE f 1. MOTOR VEHICLE FUEL440 ❑I a REGULAR UNLEADED ❑2. LEADED ❑5. JET FULL (]f marked oompletc Petroleum Type) R 1b. PREMIUM UNLEADED ❑3. DIESEL [16. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑Ic, MIDGRADE UNLEADED [14. GASOHOL 1:199.01MER, ❑3. CHEMICAI,PRODUCT COMMON NAME (Goan[{amadous Mated-Is Inventory page) 441 CAS#(Goan Hazardous Xfaterials lnvemtc rx Me) 442 04. HAZARDOUS WASTE CJa5O11ne (Includes deed Oil) D 95,UNKNOWN IIT'. TANK CONSTRUCTION TYPE OF TANK LJ 1. SINGLE WALL El 3. SINGLE WALL WITH El 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95, uNtaloWN Z 2. DOUBLE WALL ❑4. SIGNLE WALLIN VAULT 1199. OTHER TANK MATERIAL-pr maty Leek 1. BARE STEELLJ J. FIBERGLASS/PLASTIC 5,CONCRETE 0 95. IJNKN W 4444 (Check one item only) ❑2, STAINLESS STEEL 0 4, STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/I00%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank LI 1. BARE STEEL 3. FIBERGLASS/PLASTIC LJ 5. CONCRETE ❑95. UNKNOWN 445 (Chock one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS MS. r a FRP CO1lIPTIBLE 111100/o METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) 1110.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING Ell.RUBBER LINED ❑3.EPDXY LINING LJ 5.GLASS LINING D 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING (Check ox item only) ®6 UNLINED 0 99 OTHER (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ©95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE _ (For local u only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chuck all that apply) I SPILL CONTAINMENT 2003 1989 2 DROP TUBE 2003 ®1 ALARM 2()03 ®3 FILL TUBE SHUT OFF VALVE 2003 ED 3 STRIKER PLATT; ❑2 BALL FLOAT ❑4 EXEMPT IV.TANK LEAK DETECTION(A description of the monitoringprograan shall be submitted to the local agency:) IIr SINGLE WALL TANK((:heck an that apply) 453 IF DOUBLE WALL TANK OR TANK WM7 J BLADDER 454 ❑1 VISUAL(EXPOSED PORTION ONLY) C15 MANUAL TANK GAUGING (Check am item°°]Y) (MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) El 2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE 0 2 CONTINUOUS iNTERSTmAL MONrrokNG ❑3 CONTINUOUS ATO ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING_ (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 n/a n/a gallons ❑Yes ® No UPCF(12/99 revised) 10 Formerly SWRCB Form B