COMPLIANCE INFO_1996-2005 - Laserfiche WebLink

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�w-_ UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Past Z rd 1 TYPE OF ACTION Fl. NEW SITE PERMIT F 4. AMENDED PERMIT F 5. CHANGE OF INFORMATION) r 6. TEMPORARY SITE CLOSURE (Check one item only)F 2. OPERATOR CHANGE r 7. PERMANENTLY CLOSED ON SITE X 3. RENEWAL PERMIT (Spocity rowan-forlocal uce only) (Specity change-lar local use only) r 8- TANI'K REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As)3 FACILITY ID# 1 Ripon Shell LOCATION WITHIN SITE(Optional)431 341 E.Main Street,Ripon,CA 95366 .TANK DESCRIPTION (A scaled plot plan with the location of the UST system includ!ng bm s and landmarks shall be submitted to the focal agency) TANK ID# r Leo ( 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK F Yes X No 434 135816-Regular Xerxes If AYes-,complete one page for each compartment. DATE INSTALLED(YEARIMO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1996 15,000 One ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 X 1. MOTOR VEHICLE FUEL X 1a. REGULAR UNLEADED F 2. LEADED r 5. JET FUEL (If marked,complete Petroleum Type) F 1b. PREMIUM UNLEADED r 3. DIESEL F 6. AVIATION FUEL r 2. NON-FUEL PETROLEUM F 1c.MIDGRADE UNLEADED F 4. GASOHOL r99. OTHER F 3. CHEMICAL PRODUCI F 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Matenals Inventory page)441 CAS#(from Hazardous Materials Inventory page) 442 Used Oi✓) F95 UNKNOWN Ill.TANK CONSTRUCTION TYPE OF TANK r 1. SINGLE WALL F 3. SINGLE WALL WITH r 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) X2. DOUBLE WALL EXTERIOR MEMBRANE LINER r95. UNKNOWN F 4. SINGLE WALL IN A VAULT F 99. OTHER TANK MATERIAL-primary tank F 1. BARE STEEL X3. FIBERGLASS I PLASTIC F 5. CONCRETE r'95. UNKNOWN 444 (Check ono itam only) F 2. STAINLESS STEEL F 4. STEEL CLAD WIFIBERGLASS F 8. FRP COMPATIBLE W2100%METHANOL F 99. OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL.secondary r 1. BARE STEEL X3_ FIBERGLASS f PLASTIC r 6. FRP COMPATIBLE W/100%METHANOL r 95. UNKNOWN 445 tank F 2. STAINLESS STEEL F 4. STEEL CLAD W(FIBERGLASS F 9. FRP NON-CORRODIBLE JACKET F 99. OTHER (Check one item only) REINFORCED PLASTIC(FRP) F 10. COATED STEEL F 5. CONCRETE TANK INTERIOR LINING F 1. RUBBER LINED F 3, EPDXY LINING F 5. GLASS LINING F 95. UNKNOWN446 DATE INSTALLED 447 OR COATING r 2. ALKYD LINING F 4. PHENOLIC LINING X 6. UNLINED F 99. OTHER (Check one item only) (For local use only) OTHER CORROSION I' 1. MANUFACTURED X 3. FIBERGLASS REINFORCED PLASTIC r95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC F 4. IMPRESSED CURRENT F99, OTHER (Check one item only) PROTECTION (For focaf use only) F 2 SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only)451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 450 (Check all that apply) X1. SPILL CONTAINMENT_1996_ X 1. ALARM _199$_X 3. FILL TUBE SHUT OFF VALVE_1996_ X 2. DROP TUBE 1996 F 2. BALL FLOAT F 4. EXEMPT X 3. STRIKER PLATE 1996 IV. TANK LEAK DETECTION (A description of the monttonng program shall be suomiffed to the local agency) IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 r 1, VISUAL(EXPOSED PORTION ONLY) F 5. MANUAL TANK GAUGING(MTG) F 1 VISUAL(SINGLE WALL IN VAULT ONLY) F 2. AUTOMATIC TANK GAUGING(ATG) r 6. VAUOSE ZONE X2. CONTINUOUS INTERSTITIAL MONITORING r 3. CONTINUOUS ATG F 7. GROUNDWATER F 3. MANUAL MONITORING F 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ F 8. TANK TESTING BIENNIAL TANK TESTING r 99. OTHER V.TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR(MOIDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons Fye. F No UPCF(1/99 revised) Formerly SVVRCB Form B 6 6 'd b969-GL9-602 TLysegnjeW •1 aonig dS2 =E0 20 62 .add