BILLING 2006 - 2011 - Laserfiche WebLink

Home Browse Search

ANNIL IFIED PROGRAM CONSOLIDATED Fd, UNDERGROUND STORAGE TANK 1 OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. FgZ2PST closure or removal,complete only this section and Sections 4 11,Ill,IV,and IX below) 430, ❑ 1.NEW PERMITJ�9.3.RENEWAL PERMIT El 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE I❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430& I DATE EXISTING UST DISCOVERED: 430b, I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) MAItA 5'19,C- ✓I EWZef-PR S-ES It" BUSINESS SITE ADDRESS 103. CITY 104. 100 S. M Z MA-NTecA 9533 H. TANK DESCRIPTION TANK ID# 432. TANK MANUFACTURER 433. T NK CONFIGURATION:THIS TANK IS a3a. ,` L�� j E/1 Y s 1.A STAND-ALONE TANK Complete one page for each U IM /K PU( ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435, TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 1 `i 2 0 000 M. TANK USE AND CONTENTS TANK USE la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439. 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(InchW.Used 00) ❑ 5.EMERGENCY GENERATOR FUEL(MC§25281.5(c)] ❑ 6.OTHER GENE TOR FUEL ❑ 95.UNKNOWN ❑ 99-OTHER(Specify): 439& CONTENTS PETROLEUM: la.REGULAR UNLEADED ❑ ]c.MIDGRADE UNLEADED ❑ Ib.PRENUUM UNLEADED 440• ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440x. NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUMS ): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 95.UNKNOWN 443, PRIMARY CONTAINMENT ❑ 1.STEEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444. ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444x. SECONDARY CONTAINMENT ❑ 1.STEEL .FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445• ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445x. OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS X 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. 4.TANK MEETS REQUIREMENTS F R EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL 2.DOUBLE WALL ❑ 99.OTHER 460• SYSTEM TYPE x1.PRESSURE 2.GRAVITY ❑ 3.CONVENTIONAL SUCTION ❑ k SAFE SUCTION(23 CCR§2636(a 3)] 458. PRIMARY CONTAINMENT 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464& SECONDARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. ❑ 90.NONE 95.UNKNOWN ❑ 99.OTHER(Specify): 464c- PIPING/TURBINE CONTAINMENT SUMP TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644. VI. VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION 464. VENT PRIMARY CONTAINMENT [11.STEEL 4.FIBERGLASS [110.RIGID PLASTIC [190.NONE [199.OTHER(Specify): 464eel. VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC It 90.NONE ❑ 99.OTHER(Specify): 454fl. g. VR PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS [110.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464 VR SECONDARY CONTAINMENT [31.STEEL [14.FIBERGLASS [110.RIGID PLASTIC 90.NONE ❑ 99.OTHER(Specify): Ch1. VENT PIPING TRANSITION SUMP TYPE [11.SINGLE WALL ❑ 2.DOUBLE WALL 90.NONE 464t. RISER PRIMARY CONTAINMENT 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGIDPLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): �. RISER SECONDARY CONTAINMENT [IL STEEL ❑ 4.FIBERGLASS [310.RIGID PLASTIC 90.NONE EJ6kk 99.OTHER(Specify): 4 FILL COMPONENTS INSTALLED 1.SPILL BUCKET 3.STRIKER PLATE/BOTTOM PROTECTOR 4.CONTAINMENT SUMP 451a-c. VII. UNDER DISPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NONE 469& CONSTRUCTION MATERIAL ❑ 1.STEEL 4.FIBERGLASS [j 10.RIGID PLASTIC 13 99.OTHER(Specify) 46q�: VIII. CORROSION PROTECTION STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.IMPRESSED CURRENT 6.ISOLATION 448• IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate,and in full compliance with legal requirements. APPLICANT SIGNATURE DATE 470. APPLICANT NAME(print) U L C_ So rk2_M N 471, APPLICANT TITLE C � 472, UPCF UST-B Rev.(12/2007)-in www.unidoes.org