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BILLING_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231563
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BILLING_PRE 2019
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Entry Properties
Last modified
11/23/2020 4:43:00 PM
Creation date
5/2/2019 9:27:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0231563
PE
2361
FACILITY_ID
FA0000110
FACILITY_NAME
J & L MARKET
STREET_NUMBER
8115
Direction
S
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
FRENCH CAMP
Zip
95231
APN
19317003
CURRENT_STATUS
01
SITE_LOCATION
8115 S EL DORADO ST
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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FIED PROGRAM CONSOLIDATED FORM b( ANK: TA0505783 <br /> I 3 <br /> 31563 <br /> FAC#: FA02000110 <br /> UNDERGROUND STORAGE TANKS -TANK PAGE�lr `/D� <br /> (two pages per tank) <br /> TYPE OF ACTIONPage 2 of 7 <br /> (Check only item only) E] 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT �CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE <br /> j ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify tca-son-far local use only) ❑8 TANK REMOVED 430 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: PR#: l <br /> J&L MARKET 3 FA0000110 PR0231563 <br /> LOCATION WITHIN SITE(Optional) 8115 S EL DORADO ST,FRENCH CAMP 431 <br /> PHONE <br /> 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.) <br /> TANK ID# Tank#: 4 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANKyX Yes ❑No 434 <br /> TA0505783 MODERN WELDING If"Yes",complete one page for each compartment. !� <br /> DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 2 437 <br /> 6,000 <br /> ADDITIONAL DESCRIPTION(For local use only) 438 <br /> H.TANK CONTENTS <br /> TANK USE 439 PETROLEUM TYPE 440 <br /> ® I.MOTOR VEHICLE FUEL ❑ Ia.REGULAR UNLEADED ❑2.LEADED ❑ 5.JET FUEL <br /> (If marked complete Petroleum Type) <br /> ❑ lb.PREMIUM UNLEADED ® 3.DIESEL ❑ 6.AVIATION FUEL <br /> ❑2.NON-FUEL PETROLEUM ❑ Ic.MIDGRADE UNLEADED ❑ 4.GASOHOL ❑ 99.OTHER <br /> ❑ 3.CHEMICAL PRODUCT <br /> COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Iaventory page) 442 <br /> ❑ 4.HAZARDOUS WASTE <br /> (Includes Used Oil) <br /> ❑ 95.UNKNOWN <br /> HL TANK CONSTRUCTION <br /> TYPE OF TANK ❑ 1.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 <br /> (Check one item only) <br /> EXTERIOR MEMBRANE LINER E]95.UNKNOWN <br /> ® 2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑99.OTHER <br /> TANK MATERIAL-primary tank ® 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 444 <br /> (Check one item only) ❑2.STAINLESS STEEL ❑ STEEL CLAD W/FtBERGLASS ❑ 8.FRP COMPTIBLE W/100%METHANOL <br /> REINFORCED PLASTIC(FRP) ❑ 99.OTHER <br /> TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑95.UNKNOWN 445 <br /> (Check one item only) ❑ 2.STAINLESS STEEL ia 4.STEEL CLAD W/FIBERGLASS ❑ 8.FRP COMPTIBLE W/1001%METHANOL <br /> REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑99.OTHER <br /> ❑ 5.CONCRETE <br /> TANK INTERIOR LINING ❑ 1.RUBBER LINED ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 <br /> OR COATING <br /> (Check one item ❑ 2 only) ALKYD LINING ❑ BA 4 PHENOLIC LINING ❑6 UNLINED OTHER <br /> BARE STEEL (For local use only) <br /> OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 448 DATE INSTALLED 449 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> (Check one item only) ❑ 4 IMPRESSED CURRENT ❑99 OTHER <br /> y ❑ 2 SACRIFICIAL ANODE (For local tate only) <br /> SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 <br /> (Check all that apply)X <br /> �✓1 SPILL CONTAINMENT -{--m'QQ z6K of V i N ElI ALARM 3 FILL TUBE SHUT OFF VAL` 7 <br /> 2 DROP TUBE �L�7 6j� ❑ E:]2 BALL 4 EXEMPT <br /> ❑ 3 STRIKER PLATE FLOAT <br /> IV.TANK LEAK DETECTION(A dese ription of the monitoring program shall be submitted to the local agency.) <br /> IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 <br /> ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Check one item only) <br /> ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ I VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING <br /> ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑3 MANUAL MONITORING <br /> (SIR)BIENNIAL TANK TESTING ❑99 OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 <br /> ❑Yes ❑ No <br /> UPCF(12/99 revised) <br />
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