COMPLIANCE INFO_2004-2005 - Laserfiche WebLink

Home Browse Search

AOL NNUD PROGRAM CONSOLIDATED FO TANKS UNDERGROUND STORAGE TANKS-TANK PAGE i (two pages per tank) 7-T age of TYPE OF ACTION b(l NEW SITE PERMIT ❑ 4 MENDED PERMIT Q 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item may) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify rewou.-foclocal awe ally) (Specih-teasom-tbtloealaaeouly) ❑ 8 TANKREMOVED 430 1 BUSINESS- ANIEiS eaIFACII N.�A aDRa- B�iue�a ) FACILITY IB: G v ,�1 3 Yf 431 LOCATION THIN STIE(Old 1) L TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 43'_ T MA ACTURE 433 COMPARTMENTALIZED TANK Yes ❑ No -tat o If"Yes°',complete om page for each-compmtmont. DATE INSTALLED(YEAR/Mo) 43` TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTml3N s 437 tv 438 ADDITIONAL DESCRIPTION(For local use only) H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED Q 2. LEADED ❑5. JET FUEL (Ifmarked complete petroleum Type) Q lb. PREMIUM UNLEADED 'e3.DIESEL [36. AVIATION FUEL ❑2. NON-FUEL PETROLEUM C3 lc. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ' Q 3. CHEMICAL PRODUCT COMMON NAME (from Haaerldous Materials Inventory page) 441 CAS#(from Hazardous Maoetials lnventmy Pace) ❑4.HAZARDOUS WASTE occludes Used Oil) ❑95.UNKNOWN 131L TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 3. SINGLE W ALL WITH 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 11 443 (Check ow item only) EXTERIOR MEMBRANE LINER (395.UNKNOW N 2. DOUBLE WALL [14, SIGNLE W ALL IN VAULT ❑99. OTHER T.ANK1`Lq'ATERIAL-pumakmk 1.BARE STEEL 3.FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 444 (Check one item only) [3^_. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/Iwo h-tETH.ANOL Q 99.0THER REINFORCED PLASTIC(FRP) TANK LATERIAL-secondmytamk 1.BARE STEEL3.FIBERGLASS/PLASTIC 5. CONCRETE 95,UNKNOWN 415 (Check one itemonly) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [38. FRP C0111P1I8I.E Wi100"^T313MANOL 099-OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL Q 5. CONCRETE 44- TANK INTERIOR LINING [3I.RUBBER LINED 3.EPDXY LINING 5.GLASS LINING 95.UNKNOWN 446 DATE INSTALLED OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (For local we only) (Check one item only) 448 DATE INSTALLED 449 OTHER CORROSION ❑1 ALANUFACTURBD C-aTHODIC ❑3 FIBERGLASS REINFORCED PLASTIC 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Fotlocalnse allyl (Check one item only) Q 2 SACRIFICIAL ANODE 4e.2 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 45! OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check all dut apply) at SPILL CONTAINMENT Q 1 ALARM ❑3 FILL TUBE SHUT OFF VALVE 912 DROP TUBE 2 BALL FLOAT ❑4 EXEMPT 19 3 STRIKER PLATE IV.TANK LEAK DETECTION(A d9scup60n of the tnoomm"ll pm@ram shall be submitted m the local agoney.) IF SINGLE WALL TANK(Checkauthatapply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 4.v (Chale ow item only) [I I VISUAL(EXPOSED PORTION ONLY) ❑5 ALANU.AL TANK GAUGING(mro) ❑1 VISUAL(SINGLE W ALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) Q 6 VADOSE ZONE W2 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? 45" gallons ❑Yes ❑ No UPCF(12199 revised) 10 Formerly SWRCB Form B