Laserfiche WebLink
IU`,IMED PROGRAM CONSOLIDATED FO fl�(c <br /> G ,�03 TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 %7 q!\Q� <br /> (t o pages per lank) <br /> page of <br /> TYPE OF ACTION ❑I NEW SITE PERMIT ❑ 4 AMENDED PERMIT 5 CHANGE OF INFORMATION C36 TEMPORARY SITE CLOSURE <br /> X ❑ 7 PERMANENTLY CLOSED ON SITE <br /> (Cha#ow imm mny) ---- _ - -.. <br /> ❑ 3 RENEWALPERMIT (Specifymaaoa-fmlac mcmdy) Ispmify maven-forlmnl use only) ❑ 8 TANK REMOVED 430 <br /> BUSINESS NAME(Smmaa FACILI'LY NAME.,DBA-Ibbrg Busineu.As) , <br /> FACILITY ID: ' <br /> USA GASOLINE#3756 <br /> 431 <br /> LOCATION WITHIN SITE(optim,.a <br /> L TANK DESCRIPTION (A scalod plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) <br /> TANK IDk 437 TANKMANUFACTURER 433 COMPARTMENI'ALIZEDTANK Yes No 4U <br /> 3 .STIP If"Yea",complete one page far uch compamnmt. <br /> DATEINSTALLED(YEAWMO) ^i5 TANK CAPACITY IN GALLONS 4b NUMBER OF COMPARTMENTS m7 <br /> 1990 10000 <br /> AI)DI'I'IONAI.DESCRIPI'ION(Far Im.l use aid,) 4M <br /> II.TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> 01 MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL <br /> (Ifmmkdcompkte Petoolemnlype) ®lb. PREMIUM UNLEADED 03. DIESEL ❑6. AVIATION FUEL <br /> [12 NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER <br /> ❑3. CHEMICAL PRODUCT COMMON NAME (from H.doua Mw..Ialna nlmypage) 441 CAS4(from Ra doua Matenala lnvauory page) MI <br /> ❑4. HAZARDOUS WASTE <br /> (IncluMa Used Ota <br /> 0 9 UNKNOWN <br /> III. TANK CONSTRUCTION <br /> TYPE OF TANK 0 L SINGLE WALL ❑3. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Chink one item only) EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> ®2. DOUBLE WALL [14. SIGNLF.WALL IN VAULT ❑99. OTHER <br /> TANK MATERIAL-pommy mnk 0 L BARE STEEL 3. FIBERGLASS/PLASTIC ❑5. CONCRETE 0 95. UNKNOWN 444 <br /> (Grmk one�wm only) ❑2. STAINLESS STEEL ❑4, STEEL CLAD W/FIBrRGLASS ❑8. FRP COMPTBLE W/100%MET'HANOL ❑99.OTHER <br /> REINFORCED PLASTIC(FRY) <br /> TANK MATERIAL-saondary mnk 0 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN 445 <br /> (Clsekonammonly) 0 STAINLESS STEEL 04. STEEL CLADW/FBERGLASS ❑S. FRP COMPTIBLE w/100%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC GE-P) ❑ 10.COATED STEEL <br /> ❑5. CONCRETE <br /> "TANK INTERIOR LINING I.RUBBER LINED 3.EPDXY LINING 0 5 GLASS LINING U 95.UNKNOWN 44b DATE INSTALLED M7 <br /> OR COATING 0 ALKYD LINING ❑4PIENOLIC LINING 061INLINLD ❑99 OTHER <br /> (Check am item may) (Fw Ircal use only) <br /> OTHER CORROSION ❑1 MANUFACTURED CATHODIC ❑3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 <br /> PROTECTION IF APPLICABLE PROTECTION ❑4IMPRESSED CURRENT ❑99 OTHER <br /> (Check one item anly) ❑2 SACRIFICIAL ANODE (F. Ind use only) <br /> SPILL AND OVERFILL YEARINSTALLED 4w TYPE(loealoaemuy) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 457 <br /> (Clink all that apply) ® 1 SPILL CONTAINMENT 1990 ® 1 ALARM ❑3 FILL TUBE SHUT OFF VALVE <br /> ®2 DROP TUBE 1990 ®2 BALL FLOAT ❑4 EXEMPT <br /> ®3 STRIKER PLATE 1990 <br /> IV.TANK LEAK DETECTION(A desmiptioa ofmc moamomg progrom shall be submitted to the local agmry) <br /> IIF SINGLE WALL TAN K(Cluk an mat apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER dM <br /> (Clwck ane item only) <br /> ❑1VISUAL(EXPOSEDPORTION ONLY) ❑5MANUAL"LANK GAUGING(MTG) ❑1VISUAL(SINGLE WALL INVAULT ONLY) <br /> ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING <br /> (SIR) HIENNIALTANKTESTING 0 9 OTHER <br /> IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 436 1 TANK FILLED WITH INERT MATERIAL? 457 <br /> gallons ❑Yes ❑ No <br /> UPCF(1/99 revised) Formerly SWRCB Form B <br />