BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

IED PROGRAM CONSOLIDATED F04D TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) P,fftV7 TYPE OF ACTION ®I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) El 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (specify resmn-for local use only) (Specify recon-for local use only) ❑ 8 TANKREMOVED BUSINESS NAME(S.m FACILITY NAME or DBA-Doing Business As) 1 FACILITY ID: SAFEWAY STORE#2707 3 al�Q LOCATION WITHIN SITE(Optional) 4311 6425 PACIFIC AVENUE, STOCKTON,CA I.TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agen .) TANK ID# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes ® No DrA 0615 a MODERN WELDING If"Yee'.complete one page for each compartment. DATE INSTALLED(YE O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS V 2003 20,000 1 ADDITIONAL DESCRIPTION(For local use only) 4 II.TANK CONTENTS \ TANK USE 439 PETROLEUM TYPE ®1. MOTOR VEHICLE FUEL N la. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL Qfmarked complete Paunlesm Type) ❑lb. PREMIUM UNLEADED ❑3. DIESEL [16. AVIATION FUEL [12. NON-FUEL PETROLEUM ❑In. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Besardous Materimananmypaga) 441 CAS#(eom Hazvdoue Materials mvardmy page) 442 [14. HAZARDOUS WASTE Occludes Used Oil REGULAR UNLEADED 8006-61-9 ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL [13. SINGLE WALL WITH ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ®2. DOUBLE WALL [14. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary,tend, ®1. BARE STEEL [13, FIBERGLASS/PLASTIC ❑5. CONCRETE [195. UNKNOWN 444 (Check one item ody) ❑2. STAINLESS STEEL [14. STEEL CLAD W/FIBERGLASS ❑S. FRP COMPTIBLE W/100 METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-aecondazy tank ❑1. BARE STEEL 03. FIBERGLASS/PLASTIC ❑5. CONCRETE [195. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) [110.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 106 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑ 1 MANUFACTURED CATHODIC ®3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN aos DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [14 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use ody) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check d11 Net apply) ®1 SPILL CONTAINMENT Phil-Tite SC- 2003 3600-TSC-2-1 N 1 ALARM 2003 ❑3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2003 OP W 61-T ❑2 BALL FLOAT ❑4 EXEMPT ®3 STRIKER PLATE 2003 Modem Weldinla IV.TANK LEAK DETECTION(A description ofthe monitoring program shall be submitted to the[me[Vmmy.) IF SINGLE WALL TANK(Cheek dl that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ❑1 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING (SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons [:]Yes [:1 No UPCF(12/99 revised) 10 Formerly SWRCB Form B