COMPLIANCE INFO_FILE 11 - Laserfiche WebLink

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871-D1U2 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (tiro pages per tank) Page ]_ of 9 TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4.AMENDED PERMIT ❑ 5.CHANGE OF INFORMATION) ❑ S. TEMPORARY SITE CLOSURE (Check one item only) ❑ 7. PERMANENTLY CLOSED ON SITE 113.RENEWAL PERMIT (Specify reason-for local use only) (Specify change-for local useorrly) ❑ 8. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID M -, 1 j I I IT Lawrence Livermore National Laboratory Site30 LOCATION WITHIN SITE(OphonaQ 431 North nf Ri,ilaiTig 871 1.TANK DESCRIPTION TANK IDM TANK MANUFACTURER COMPARTMENTALIZEDTANK ❑ Yes No 8 71-D 1 U 2 Modern Welding Co 11"Yee,complete one page for each compartment DATE I (YEARIMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS 94/09 1 ADDITIONAL DESCRIPTION(Forlocal use a*) 11.TANK CONTENTS TANK USE 432 PETROLEUM TYPE C} 1.MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED ❑2. LEADED ❑ 5.JET FUEL (N marked,complete Petroleum Type) ❑Ib.PREMIUM UNLEADED M 3. DIESEL ❑ e. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1a MIDGRADE UNLEADED ❑ 4.GASOHOL ❑99. OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME(ham Hazardous Materials Inventorypage) CAS M(hem Hazardous,Materials Inventory 13 4. HAZARDOUS WASTE(includes page) Uaed00) Diesel Fuel 64742-80-9 95 KNOM 10.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item only) ] 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑95. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑99 OTHER TANK MATERIAL-primary tank 1 BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE ❑95. UNKNOWN (Check one item orgy) �❑ 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 ❑ 3. FIBERGLASS/PLASTIC ❑ 8. FRP COMPATIBLE W/100%METHANOL ❑95. UNKNOWN (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 LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 DATE INSTALLED OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING 10 & UNLINED 1199. OTHER (Check one item o Forlocal use o OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 DATE INSTALLED PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99.OTHER (Check one item only) ❑ 2. SACRIFICIAL ANODE (Forloral use only) SPILL AND OVERFILL YEAR INSTALLED TYPE(Forloca/use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED _(Check as that appw 10 1 SPILL CONTAINMENT 1994 0 1.ALARM 1 g q 6I) 3. FILL TUBE SHUT OFF VALVE 199 KI 2. DROP TUBE 1994 2. BALL FLOAT 1 9 9 4❑ 4. EXEMPT ® 3. STRIKER PLATE 1_994 1V:'17ANK'LEAKDETEC3)ON, IF SINGLE WALL TANK Check ad that a IF DOUBLE WALL TANK OR TANK WITH BLADDER Check one item o ❑ 1, VISUAL(EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ 6. VADOSE ZONE R3 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑4. STATISTICAL INVENTORY RECONCILIATION(SIR)r ❑ B. TANK TESTING BIENNIAL TANK JESTING [199. OTHER V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE FILLED WITH INERT MATERIAL? ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK gallons ❑Yes ❑No CUPAFORM(4199) Formerly SWRCB Form B