COMPLIANCE INFO_1999-2009 - Laserfiche WebLink

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ows UNHUD PROGRAM CONSOUDATED FORM TANKS UNDERGROUND STORAGE T - TANK PAGE 1 (TWO pages par tank) Page � of _ TYPE OF ACTION ❑ R. NEW PERMIT ❑ 4. A•MF.NDED PERMIT 0 S. CHANGE 01: INFORMATION ❑ 6. TEMPORARY TANK CLOSURE 430. (Chwkorcnaoariy) ❑ 3. RENCWAL PI'J2A4iT ❑ 7. PERMANENTLY CIMED ON SITE Opoory ) fsifr rte") Q 8. TANK REMOVED BUSINESS NAME (s.. PAc NAMl;or DDA -Doing Ilminoq As) 5. 1 FACILITY IP:_TTI 1 I. iQvt9Y( 6M D®Ari LOCATION WITHIN SI1'LA,N oP) 431. • p�� SZ• 1,-,' f. TA. •AES SON: A•scalad. ttn witti:the loc Boal 01 ihc';UJST system iacl*linR,buiIdjh ° and larldnmricsshall be submitted to thb:iocat. ) TANK ID # 4377 TANK MANUFAC.TURL^'R 433. r ( o COMPARTA9ENTALIZP-L) TANK ❑ Yes ❑ No 434. [l `�' to^vc"Cmacom Pw for eam0npm•tmenc DATE INSTALLRT) 435. TANK CAPACITY IN GALLONS 436• NUM8ER OF COMPARTMENTS (YEAR/MO) 437. i- 1©, AVIJIIIVNA1. DESCRIPTION (Forlod ape only) 438 T...A/// K USE 439 PETROLEUM TYPE �� pC I. MOTOR VEHICLE FUEL ® Ia. REGULAR UNLEADED E3 2. LEADED ❑ 5. JET FUEL 460. ardwamet tomWdePetolemlyp) ❑ Ib. PREMIUM UNLEADEDDIF$i?j ,• ❑ 6. AVIATION GAS ® 2. NON -PGE1, PIETRUI r[Jl«r ❑ 14. MII GRADE UNLEADED • ❑ 4. GASOHOL ❑ 99. OTHER, ti ❑ 3. Ci rmcAL PRODUCT COMMON NA ME (from Hazardous Mmww,% IA ry p p) 441. CASA (from "W Ivory Page) 442. ® 4. HAZARDOUS WASTE (ladra�t;�0;q ❑ 95. UNKNOWN 111. TANK CONSTRUCrION TYPE OF TANK (] I. SINGLE wALI. ❑ 3. SINGLE WAIL WITH EXTERIOR [15. SINC3Lr WALL WITfi INTERNAL BLADDER SYSTEM 443. (Check one item may) MEMBRANE LINER ❑ 95. UNKNOWN DOUBLE wA13, ❑ 4. SINGLE wnr,L UN A VAULT 99. O'TiiER TANK MATERIAL-Imimwy, . itARrSTEEI. 3. FIBERGLASS/PLASTIC 5. CONCRETE 0 93. UNKNOWN 44q (0100 of kem a iy) ❑ 2. STAINLESS STEEL ❑ 4. S17EMR - CLAD W/FTBERG"A. ❑ S. FRP COMPA'TtBl.r ❑ 99.OTHFR: REINPORCED PLASTIC W/IOM METHANOL TANK MATERIAL - secondary eqnk ❑ 1. SART STLTL ❑ 3. FIBERGLASS /PLASTIC jsl 8. FRPCOMPTiBLE W/Itb%METHANOL E3 95, UNKNOWN 445. (Check ono item only) ❑ 2. STAINLESS STEEL K4. STEL,n CLAD WTIBERGLASs ❑ 9. FRP NON-CORRODABLF, JACKET 0 99, OTHER REWFORCED PLASTM (FRP) ❑ IU. ('OATED STEEL 5. CONCREIM TANK INTERIOR LINING ❑ 1. RUSSER LINED ❑ 3. EPDXY LINING GLASS I.TNING ❑ 95. UAIKNOWN 446. DATE INSTALLED 441. OR COATING C3 2. ALKYD LINING ❑ 4. PHENOLIC LINING ; . UNIVED ❑ 99. OTHER Cmc one itzm OTHER CORROSION 0 t, MANUFACTURED CATI IODIC 3. FIBERGLASS REAJFORCED PLASTIC 95. UNKNOWN 449, DATE 1NSTALLFS! 449, PROTECTION PRal'EC:TION ON, IAII'RFSSEDCURRENT ❑ 99. OTHER (IfA1dewel Q 2. SACRIFICIAL ANODE - SPILL AND OVERFILLLED 450. (C k all that apply). SPILL CONTAINMENT131. TYPE 0L OVERFILL PROTECTION UIPMENT: YEAR INSTALLED 5 ALARM FILL TUBE SHUT OFF VAtvr DROP Tutlr r ,.��. ,,..... _.. ..MIX . [12. BALL FLOAT 4. EXEMPT i.v. 1 rax�Itti ik.cA.7n )i7.1C A1Gi: iliJly (A description of the monitoring progm:SbO.: be submitted to the local agency,) If SINGLE WALI, TANK 454• IF DOUBLI: WALT. TANK OR TANK WITH BLADDER 454• (Chock all th u g4ay) (CbeCk one itmn only) 111. VISUAL (EMSF.D PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MIG) ❑ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING (A•1 -G) ❑ 6. VADOSE ZONE . CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATO ❑ 7. GROUNDWATER ❑ 3. MANIJAt. MONITORING [2 4. STATISTICAL INVENTORY RECONCILIATION ❑ 8. TANK *MTm (SIR)+BIENNIAL TANK TTST]ING ❑ 99. O•Imm V. ''AN kCLOSUREDW> • •'TION / PERMANENT CLOSURE, IN PLACE ESTIMATED DATE LAST USfih) (YR/MO/DAY) 455. ES•LyATED QUANII-1Y OF SUBSTAN(.'E REMAINING 4 TANK FILLEED WITH INERT MATERIAL? 457. _... - .. ! ❑ Yes ❑ No UPCF bwftffc-b (IM) - 1/4 www.unidomorg 9TO/ 6001d OOOZ# 60:tO 90OZ/ZZ/90