BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

U ,iD PROGRAM CONSOLIDATED F` , MkW,II 1 ( 'Z UNDERGROUND STORAGE TANKS -TANK P14GE 1 JUN 11 20Urpnk) .�.• ��tank) (j�PbJAI 02 Page T of TYPE OF ACTION r I. NEW SITE PERMIT r 4. AMENDED PERMIT r 5. CHANGE OF INFORMATION) r 6. TEMPORARY SITE CLOSURE (Check one item only)r 2. OPERATOR CHANGE r 7. PERMANENTLY CLOSED ON SITE r3. RENEWAL PERMIT (Specify reason-/or local use only) (Specify change-Por focal use only) r 8. TANr K REMOVED 430 U BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As)3 FACILITY 10# 1 Ben Holt 11-6 Shell I Aai LOCATION WITHIN SITE(OpbonapA31 3011 W Benjamin Holt, Stockton, CA 95219 1.TANK DESCRIPTION fAscaled pbt#an with the Mcahon of the UST system including buildings and landmarks shall be submitted oft legal agency.) TANK ID# y TA05o59sq 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK r Yes XNo 136148-Regular Xerxes If AYes=_,complete we page for each winpatment- DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 1995 15,000 ONE ADDITIONAL DESCRIPTION(For foal use only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 X 1. MOTOR VEHICLE FUEL X ia. REGULAR UNLEADED r 2. LEADED r 5. JET FUEL (Ifmarked,complete Petroleum Type) r1b. PREMIUM UNLEADED r 3. DIESEL r 6. AVIATION FUEL r 2. NON-FUEL PETROLEUM r1c MIDGRADEUNLEADED r 4. GASOHOL r99. OTHER r.3. CHEMICAL PRODUCT r 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Matenals Inventory page)441 CAS#(from Hazardous Materials Imeaory page) 442 Used Oil) F95. UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK r 1. SINGLE WALL r 3. SINGLE WALL WITH r 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) X2. DOUBLE WALL EXTERIOR MEMBRANE LINER r95. UNKNOWN r 4. SINGLE WALL IN A VAULT F 99. OTHER TANK MATERIAL-prknary tank r 1. BARE STEEL X3. FIBERGLASS/PLASTIC r 5. CONCRETE r95. UNKNOWN 444 (Check one item only) r 2. STAINLESS STEEL r4. STEEL CLAD WIFIBERGLASS r 8. FRP COMPATIBLE Wit 00%METHANOL r99. OTHER REINFORCED PLASTIC FRP TANK MATERIAL-secondary [' 1. BARE STEEL X3. FIBERGLASS/PLASTIC r 8. FRP COMPATIBLE W/100%METHANOL r95. UNKNOWN 445 tank r 2 STAINLESS STEEL r 4. STEEL CLAD W/FIBERGLASS r 9 FRP NON-CORRODIBLE JACKET r 99 OTHER (Check one item only) REINFORCED PLASTICFRP ( ) F10. COATED STEEL r 5. CONCRETE TANK INTERIOR LINING r 1. RUBBER LINED r 3. EPDXY LINING r 5. GLASS LINING r 95. UNKNOWN446 DATE INSTALLED 447 OR COATING F 2. ALKYD LINING r 4. PHENOLIC LINING X 6. UNLINED r 99. OTHER Check chairman, Forlocal usa onl OTHER CORROSION r i. MANUFACTURED X 3. FIBERGLASS REINFORCED PLASTIC r 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC PROTECTION r4. IMPRESSED CURRENT r99. OTHER (Check one item only) (Fwfocal use only) r 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocal use only)451 OVERFILL PROTECTION EQUIPMENT.YEAR INSTALLED 452 450 (Check as that apply) X1. SPILL CONTAINMENT_1995_ X1. ALARM _1998_X3. FILL TUBE SHUT OFF VALVE 1995_ X2 DROP TUBE 1995 r 2. BALL FLOAT r 4. EXEMPT X 3. STRIKER PLATE _1995_ IV. TANK LEAK DETECTION (A descnptich of the monitwing program shall be submitted Po the local agency.) -..I IF SINGLE WALL TANK(Check all that apply). 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 r 1, VISUAL(EXPOSED PORTION ONLY) r 5. MANUAL TANK GAUGING(MTG) r 1. VISUAL(SINGLE WALL IN VAULT ONLY) F 2. AUTOMATIC TANK GAUGING(ATG) r 6. VADOSE ZONE X2 CONTINUOUS INTERSTITIAL MONITORING r3. CONTINUOUS ATG r 7. GROUNDWATER r 3. MANUALMONITORING r4. STATISTICAL INVENTORY RECONCILIATION(SIR) r8. TANK TESTING BIENNIAL TANK TESTING r99. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LIAST USED(YRIMOIDAY) 455 ESTIMATED QUANTITY OF SU REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 1 n g e).J gallons r Ves r No 6