COMPLIANCE INFO_2001-2009 - Laserfiche WebLink

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�IFIED PROGRAM CONSOLIDATED FOR*TANK: TA0508178 PR #: PRO231692 . UNDERGROUND STORAGE TANKS - TANK PAGE I FAC #: FA0000212 ' 744103 (two pages per tank) 6 of 7 TYPE OF ACTION ❑ 1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATIONPage ❑ 6 TEMPORARY SITE CLOSURE (Check only Iran only) ❑ 7 PERMANENTLY CLOSED ON SITE �..,�-s 1F' i RENEWAL PERMIT ME= ❑ 8 TANK REMOVED 430 1191M BUSINESS NAME Same m FACILITY NAME or DBA - Doing Business As ( g ) FACILITY ID: PR #: I MBP MOSSDALE* 3 FA0000212 PR0231692 LOCATION WITHIN SITE (optional) 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 #: 6 432 TANK MANUFACTURER D 433 P COMPARTMENTALIZED TANK ❑ Yes No a34 TA0508178 RP If "Yes", complete one page for each comment part DATE INSTALLE (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4,000 3 ADDITIONAL DESd.RI DESTIO (For local use only) 438 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ❑ la. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If narked complete Petroleum Type) *l b. PREMIUM UNLEADED gF3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON-FUEL PETROLEUM ❑ 1 c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (fiwn Hazardous Materials hrvrn I� page) 441 CAS# from Hazardous Materials Invent a ( Inventory page) g) 442 E]4. HAZARDOUS WASTE (Includes Used Oil) ❑ 95. UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one itemonly) 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 item only) ❑ 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 (Check one item only) ❑ 2. STAINLESS STEEL�.4. STEEL CLAD W/FIBERGLASS E]8. FRP COMPTIBLE W/100%METHANOL VXJREINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ 99. OTHER ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING (Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING ® 6 UNLINED ❑ 99. OTHER (For 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) E]4 IMPRESSED CURRENT ❑ 99 OTHER ❑ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 1 SPILL CONTAINMENT (Check all that aPPIY) � � ❑ 1 ALARM �4EXEMPT 3 FILL TUBE SHUT OFF VAL` �2DROPTUBE 2BALL � -�G rG'\ STRIKER PLATE61 FLOAT IV. TANK LEAK DETECTION (A description of the monitoring program shall be subm tted 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 one 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 REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 0.00 gallons ❑ Yes ❑ No UPCF (12/99 revised)