COMPLIANCE INFO_1986-2006 - Laserfiche WebLink

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-� -a�-L�3 FF UNIFIED PROGRAM CONSOLIDATED FORM TANKS F UNDERGROUND STORAGE TANKS-TANK PAGE 1 - (two pages per tank; I Page _ of _ S. CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE TYPE OF ACTION ❑1.NEW SITE PERMIT 4.AMENDED PERMIT ❑ 7, PERMANENTLY CLOSED ON SITE (Check one item only) ❑3.RENEWAL PERMIT (Sp y reason•/orloca!use only) -(Sp. change-for local use only) ❑ 8.TANK REMOVED 430 TTFFF-'BUSINESS NAME(Same as FACILITY NAME or DBA•Doing Business As) FACILITY 10# LOCATION WITHIN SITE(Optidnaq 1 1.TANK DESCRIPTION TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes No TANK ID# / L If'Yee,complete one page for each comPWIrnent w ® Q 3 '" - NUMBER OF COMPARTMENTS DAT INSTALLED(YEARIM0) TANK CAPACITY IN GALLONS 3 C ADDITIONAL DESCRlPT1ON(Far local use only) - 11.TANK CONTENTS TANK USE 432 PETROLEUM TYPE ❑ 5.JET FUEL ❑to REGULAR UNLEADED ❑ 2. LEADED l/✓ 'q/ /: 1. MOTOR VEHICLE FUEL 3. DIESEL veh'Co j ❑ 6. AVIATION FUEL (if marked.complete Petroleu.^i Type) ❑tp. PREMIUM UNLEADED ❑99. OTHER MIDGRAOEUNLEAOED ❑ 2. NON-FUEL PETROLEUM ❑ 4. GASOHOL ❑tc. CAS#(from Hazardous Materials Inventory page) ❑ 3. CHEMICAL PROOUC7 COMMON NAME(from Hazardous Materials Inventory page) ❑ 4. HAZAROOUS WASTE(Includes Used Oil) 111.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3..SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM EXTERIOR MEMBRANE LINER ❑95. UNKNOWN (Check one item only) 2. DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT ❑94. OTHER TANK MATERIAL-primary tark ❑ 1 BARE STEEL ❑ 3. FIBERGLASS 1 PLASTIC ❑ 5. CONCRETE >1,95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ B. FRP COMPATIBLE WI100%METHANOL ❑99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL.secondary tank ❑ 1. BARE STEEL ❑ 3 FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE W1100%METHANOL . 95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD WIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑ 5. CONCRETE DATEINSTALLEO ❑ t. RUBBER LINED ❑ 5. GLASS LINING �95. UNKNO'MI433 TANK INTERIOR LINING ❑ 3. EPDXY LINING ❑ 6. UNLINED ❑99. OTHER IF:Orl OR COATING ❑ 4. PHENOLIC LINING OATS N ❑ 2. ALKYD LINING GATE INSTALLED (Check one item only) 95. UNKNOWN 434 OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑99. OTHER PROTECTION IFAPPLICA3'-E PROTECTION ❑ 4. IMr'RESSEDCURRENT (For)ocaf (Check one item only) ❑ 2. SACRIFICIAL ANODE OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED SPILL AND OVERFILL YEAR INSTALLED TYPE(Forlocal use only) rrrrff (Check an that appb') 1.ALARM '�-%`0 7, CJ 3. FILL TUBE SHUT OFF VALVE,I X)3; ❑ 1, SPILL CONTAINMENT r� W 2. BALL FLOAT ❑ 4. EXEMPT ❑ 2. DROP TUBE - ❑ 3. STRIKER PLATE ... IV.TANK LEAK DETECTION IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item onry): IF SINGLE WALL TANK Check all that app )* ❑❑ 5. MANUAL TANK GAUGING(MTG) 1. VISUAL(SINGLE WALL IN VAULT ONLY) , ❑ 1, VISUAL(EXPOSED PORTION ONLY) 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)• ❑ 8. TANK TESTING BIENNIAL TANK TESTING 099. OTHER V.TANK CLOSURE INFORMATION f PERMANENT CLOSURE 14 SLAC TANK FILLED Yn7H INERT MATERIAL? ESTIMATED DATE LAST USED(YRIMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING gallons ❑Yes ❑No Formerly SYVRCB Form CUPAFORM(4)99)