COMPLIANCE INFO_1997-2002 - Laserfiche WebLink

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1 D1 DMA `I q-r, UNIFIED PROGRAM CONSOLIDATED FORM `�//b/02- TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (twin pages per tank) Page of_ TYPE OF ACTION [:11. NEW SITE PERMIT ❑4. AMENDED PERMIT ®5. CHANGE OF INFORMATION) ❑6. TEMPORARY SITE CLOSURE (Check one item only) ❑7. PERMANENTLY CLOSED ON SITE ❑3. RENEWAL PERMIT [:18. TANK REMOVED 430 (Sped reason-for loco/use only) (Specify change-for local use only) BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# 1 Tosco Corporation#2611195/11195/30225 LOCATION WITHIN SITE(Optional) 431 L TANK DESCRIPTION (A scaled plot plan with the location ojthe UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# 432 TANK MA FACTURER 433 COMPARTMENTALIZED TANK E] YesNo 434 -r� o5pg�3 ( P ( If[]Yes L;,complete one page for each comp n m DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 Mq la O ADDITIONAL DESCRIPTION(For local use only) 438 II.TANK CONTENTS �/ TANK USE 439 ��,,��,,//,,//// PETROLEUM TYPE 440 . MOTOR VEHICLE FUEL a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (Ijm Irked,complete Petroleum Type) 1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑lc. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑3. CHEMICAL PRODUCT ❑ 4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 Used Oil) ❑95. XERXES III.TANK CONSTRUCTION TYPE OF TANK 1:11, SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. XERXES (Check one item only) ❑ 4. SINGLE WALL IN A VAULT ❑99 OTHER TANK MATERIAL-primary tank ❑1. BARE STEEL P511FIBERGLASS/PLASTIC [-]5. CONCRETE ❑95. XERXES 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/100%METHANOL ❑99. OTHER REINFORCED PLASTIC FRP TANK MATERIAL-secondary tank ❑1 BARE STEEL FIBERGLASS/PLASTIC ❑8. FRP COMPATIBLE W/100%METHANOL ❑95. XERXES 445 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODIBLE JACKET ❑99. OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINEDDATE INSTALLED 447 OR COATING 3. EPDXY LINING 5 GLASS LINING 95. XERXES 446 ❑2. ALKYD LINING ❑4. PHENOLIC LINING .UNLINED ❑99. OTHER Check one item only) For local use onl OTHER CORROSION ❑L MANUFACTURED 3. FIBERGLASS REINFORCED PLASTIC ❑95. XERXES 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE CATHODIC 4. IMPRESSED CURRENT ❑99. OTHER PROTECTION (Check one item only) ❑2 SACRIFICIAL.ANODE (For local use only) SPILL AND OVERFILL YEAR 1450 TYPE(For local use only) 451 OVERFILL PROTECTION EQUIX'ILL :YEAR INSTALLED n,� 452 (Check all that apply) 1. SPILL CONTAINMENT ❑1. ALARM TUBE SHUT OFF VALVE DROP TUBE ❑2. BALL FLOAT ❑4. EXEMPT STRIKER PLATE IV. TANK LEAK DETECTION (A description ojthe monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item onlv): 454 F-11, VISUAL(EXPOSED PORTION ONLY) ❑5. MANUAL TANK GAUGING(MTG) ❑L VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6. VADOSE ZONE 6122. CONTINUOUS INTERSTITIAL MONITORING ❑3. CONTINUOUS ATG ❑7. GROUNDWATER 3. MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ ❑8. TANK TESTING BIENNIAL TANK TESTING ❑99. OTHER V.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? 457 gallons �. Yes No ._ UPCF(1/99 revised) Formerly SWRCB Form B