BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

Ak AAL MIFIED PROGRAM CONSOLIDATED FOOR UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections I,II,III,IV and IX below) 430 ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430x. I DATE EXISTING UST DISCOVERED: 430b L FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. WEST VALLEY AUTO SPA INC. BUSINESS SITE ADDRESS 103 CITY 104. 2615 West GRANT LINE ROAD I TRACY IL TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. TA OS1S938- j�S ® 1.A STAND-ALONE TANK Complete one page for each 2.ONE IN A COMPARTMENTED UNIT cmPffft tent in the unit. DATE UST SYSTEM INSTALLED 435• TANK CAPACITY IN GALLONS 436. ER OF COMPARTMENTS IN THE UNIT 437. JUNE 1,2004 10,000 7i III. TANK USE AND CONTENTS TANK USE ® la MOTOR VEHICLE FUELING ❑ 1 b.MARINA FUELING ❑ lc.AVIATION FUELING 439• ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Ind d.Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC¢25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 439x. CONTENTS PETROLEUM: ❑ 1 A REGULAR UNLEADED ❑ 1 c.MIDGRADE UNLEADED ® l b.PREMIUM UNLEADED 440 ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM(Specify): 440a. NON-PETROLEUM:0 7.USED OIL U 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443. PRIMARY CONTAINMENT ❑ L STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444• ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 445• ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a. OVERFILL PREVENTION 1.AUDIBLE&VISUAL ALARMS ® 2.BALL FLOAT ❑ 3.FILL TUBE SHUT-OFF VALVE 452. rJ 4.TANK MEETS REQUMEMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER 460. SYSTEM TYPE_ ® 1.PRESSURE ❑ 2.GRAVITY [1 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR f2636(sX3)] W. PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a. SECONDARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ S.FLEXIBLE ❑ 10.RIGID PLASTIC 4646- 0 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a PIPING/TURBINE CONTAINMENT SUMP TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 4644. VL VENT, VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ® 1.STEEL [14.FIBERGLASS [310.RIGID PLASTIC [190.NONE ❑ 99.OTHER(Specify): 4WI. -- VENT SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464 fl. 464g- VR PRIMARY CONTAINMENT ® L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): k VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 464hl. VENT PIPING TRANSITION SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 9o.NONE RISER PRIMARY CONTAINMENT ® 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 1: RISER SECONDARY CONTAINMENT ❑ L STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE ❑ 99.OTHER(Specify): 4664kl. FILL COMPONENTS INSTALLED ® 1.SPILL BUCKET ® 3.STRIKER PLATFJBOT 0M PROTECTOR ® 4.CONTAINMENT SUMP 451a-a VIL UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 3.NO DISPENSERS ❑ 90.NO - 469a. CONSTRUCTION MATERIAL ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) ' _ 469c. VIII. CORROSION PROTECTION "@ STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODES ❑ 4.HvvIPRESSED 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 a is true, accurate,and in full cynipliangelwith requirements APPLICANT SIGNATURE DATE 3/28/2011 �� 470. i=.... APPLICANT NAME(primo A HALL 471. APPLICANT TITLE OPERATOR .:: 472.