COMPLIANCE INFO_2001-2009 - Laserfiche WebLink

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PROGRAM CONSOLIDATED FO TANK: TA0508177 0 8NIFIED PR #: PRO231692 UNDERGROUND STORAGE TANKS - TANK P 1 FAC #: FA0000212 t23D3 (two pages per tank) TYPE OF ACTION ❑ I NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATIONPage 4 of 7 ❑ 6 TEMPORARY SITE CLOSURE (Checkonlyi-only)',SPEP °IBiI [-]7PEP MANENTLYCLOSED ONSITE +N. 3 M! RENEWAL PERMIT ❑ 8 TANK REMOVED 430 BUSINESS NAME (Same as FACB,rrY NAME or DBA - Doing Business As) FACILITY ID: PR #: l MBP MOSSDALE* 3 FA0000212 PR0231692 LOCATION WITHIN SITE (optiowl) 444 W MOSSDALE RD, LATHROP 431 PHONE I. 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# Tank #: 5 432 TANK MANUFACTURER S 433 COMPARTMENTALIZED TANK Yes [:]No 434 TA0508177 1 If °Yes•, oanylete ate page fa each aanparhrcnt. DATE INST D (YE O) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTWTS 437 11 j 6,000 ADDITIONAL DESCRIPTION (For local use only) 438 H. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL JF1 a. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If marked cotplete Petrolou n Type) '*b. b. PREMIUM UNLEADED 3. DIESEL ❑ 6. AVIATION FUEL F-12. NON -FUEL PETROLEUM ❑I c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAMEfrom Hazardous Materials Inventory ory page) 441 CAS# (from Harardahs Materials Inventory page) 442 ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ t. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ® 2. DOUBLE WALL ❑ 4. SINGLE WALL IN VAULT ❑ 99. OTHER TANK MATERIAL. - primary tank ® 1. BARE STEEL ❑ FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 444 (Check one itemoly) ❑ 2. STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/ 100% METHANOL REINFORCED PLASTIC (FRP) ❑ 99. OTHER TANK MATERIAL - secondary tank ❑ 1. BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN 445 (Checkoheitemonly) ❑ 2. STAINLESS STEEL K4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPTIBLE W/100% METHANOL REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 99. OTHER ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING447 ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED OR COATING (Cheek one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99. OTHER (Fa local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ® 3 FIBERGLASS REINFORCED PLASTIC ❑ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION (Check one item only) ❑ 4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2 SACRIFICIAL ANODE (Fa local use only) SPILL AND OVERFILL YEAR IINSTALLE450 TYPE (local use o ly) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) K 1 SPILL CONTAINMENT 1:1 6M&0 E]1 ALARM FILL TUBE SHUT OFF VAL' C r 2DROPTUBE_l R2 BALL ❑ 4EXEMPT STRIKER PLATE FLOAT IV. TANK LEAK DETECTION (A description of the 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 454 ❑ 1 VISUAL (EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING (MTG) (Check we item only) ❑ 2 AUTOMATIC TANK GAUGING (ATG) ❑ 6 VADOSE ZONE ❑ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ® 2 CONTINUOUS INTERSTITIAL MONITORING ❑ 4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING ❑ 3 MANUAL MONITORING (SIR) 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 REMAININGNK FILLED WITH INERT MATERIAL? 457 " 9"+ 0.00 gallons 1 7T� ❑ Yes ❑ No UPCF (12/99 revised)