COMPLIANCE INFO_2007-2012 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (Two pages per tank) Pagel of2 TYPE OF ACTION ❑ I.NEW PERMIT ® 4.AMENDED PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. (Check one dem only) ❑ 3.RENEWAL PERMIT Tank Size-8K to IOK ❑ 7.PERMANENTLY CLOSED ON SITE (Specify reason) (Specify reason) ❑ 8.TANK REMOVED BUSINESS NAME(Same w FACILITY NAME or DBA-Doing Business As) 3. FACILITY ID: 1 Pacific Bell Telephone Company dba AT&T California LOCATION WITHIN SITE(optional) 431. I.TANK DESCRIPTION A scaled plot ptm with the location of the UST system including buildings and landmarks shall be submitted to the local a enc .) TANK ID# 432. TANK MANUFACTURER 433• COMPARTMENTALIZED TANK Lj Yes N No 434. 1232 Modern Welding If"Yes."complete one page for each compartment. DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436• NUMBER OF COMPARTMENTS 437. (YEAR/MO) 2003/01 10,000 ADDITIONAL DESCRIPTION(For kxal use only) 438. IL TANK CONTENTS TANK USE 439. PETROLEUM TYPE 440. ® 1. MOTOR VEHICLE FUEL ❑]a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If checked,complete Petroleum Type) ❑Ib. PREMIUM UNLEADED ®3. DIESEL ❑6. AVIATION GAS ❑ 2. NON-FUEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL [199.OTHER: ❑ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442. ❑ 4. HAZARDOUS WASTE (Includes Used Oil) 1395.UNKNOWN III.TANK CONSTRUCTION TYPE OF TANK 0 1. SINGLE WALL 3. SINGLE WALL WITH EXTERIOR 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) MEMBRANE LINER [195. UNKNOWN 2. DOUBLE WALL 4. SINGLE WALL M A VAULT 99. OTHER TANK MATERIAL-primary tank ®I. BARE STEEL 3. FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 444. (Check one item only) [32. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE ❑99.OTHER: REINFORCED PLASTIC FRP W/100%METHANOL TANK MATERIAL-secondary tank I. BARE STEEL 3. FIBERGLASS/PLASTIC ❑8. FRP COMPTIBLE W/100%METHANOL 0 95.UNKNOWN 445. (Check one item only) ❑2. STAINLESS STEEL®4. STEEL CLAD W/FIBERGLASS ❑9. FRP NON-CORRODABLE JACKET ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10. COATED STEEL 5. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED 3.EPDXY LINING [15.GLASS LINING ❑95.UNKNOWN 446. DATE INSTALLED 447. OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ®6.UNLINED ❑99.OTHER Check one item onlyL OTHER CORROSION E3 1.MANUFACTURED CATHODIC 0 3.FIBERGLASS REINFORCED PLASTIC 95.UNKNOWN 448. DATE INSTALLED 449. PROTECTION PROTECTION ❑4.IMPRESSED CURRENT ❑99.OTHER 2003 If Applicable) 2.SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450. TYPE 451. OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452. (Check all that apply) ®1.SPILL CONTAINMENT 2003 ®I.ALARM 2003 ❑3.FILL TUBE SHUTOFF VALVE ®2.DROP TUBE 2003 ❑2.BALL FLOAT ❑4.EXEMPT ®3.STRIKER PLATE 2003 IV.TANK LEAK DETECTION (A description of the monitorin shall be submitted to the local agency.) IF SINGLE WALL TANK 453. IF DOUBLE WALL TANK OR TANK WITH BLADDER 454. (Check all that apply) (Check one item only) ❑1. VISUAL(EXPOSED PORTION ONLY) ❑S.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) ❑2. AUTOMATIC TANK GAUGING(ATG) [16,VADOSE"LONE ®2.CONTINUOUS INTERSTITIAL MONITORING ❑3.CONTINUOUS ATG [17.GROUNDWATER ❑3.MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING (SIR)+BIENNIAL TANK TESTING ❑99. OTHER V.TANK CLOSURE INFORMATION/ PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MODAY) 455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456. TANK FILLED WITH INERT MATERIAL? 457. gallons ❑Yes ❑ No UPCF hwfwrc-b(1/44)-1/4 www.unidocs.org Rev.02/16/00