COMPLIANCE INFO_FILE 11 - Laserfiche WebLink

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875-D1U2 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page L of TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 6. TEMPORARY SITE CLOSURE (Check one item only) 3. RENEWAL PERMIT ❑ 7. PERMANENTLY CLOSED ON SITE M (Specify reason - for local use only) (Specify change - for local use only) ❑ 8. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY ID # Lawrence Livermore National Laboratory Site 3 0 t`.w�iffi `. ak LOCATION WITHIN SITE (Opdonaq 431 I. TANK DESCRIPTION ' TANK ID # TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes No 875-D1U2 Modern We Wing Co..Inc If"Yes', complete one page for each compartment. DATE INSTALLED (YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS 92/07 3000 1 ADDITIONAL DESCRIPTION (Forlocal use only) North of Building 875 II. TANK CONTENTS TANK USE - 432 PETROLEUM TYPE KI 1. MOTOR VEHICLE FUEL ❑ 1a. REGULAR UNLEADED 2. LEADED ❑ S. JET FUEL (d marked, complete Petroleum Type) ❑ Ib. PREMIUM UNLEADED - Io❑ OU 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ 1c. MIDGRADE UNLEADED ❑ 4. GASOHOL 1199. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME prom Hazardous Materials Inventory page) CAS # (from Hazardous Matenals Inventory page) ❑ 4. HAZARDOUS WASTE (Includes Used od) Diesel Fuel 64742-80-9 111. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item only) g1 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN �❑ 4. SINGLE WALL IN A VAULT ❑ 99 OTHER TANK MATERIAL - primary tank KI 1. BARE STEEL ❑ 3. FIBERGLASS/ PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL ❑ 4. STEEL CLAD W/FIBERGLASS ❑ 8. FRP COMPATIBLE W/100% METHANOL 1199. 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) 1110. 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 1[1 6. UNLINED ❑ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION PROTECTION IF APPLICABLE ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC 1195. UNKNOWN 434 DATE INSTALLED PROTECTION ❑ 4. IMPRESSED CURRENT ❑ 99. OTHER (Check one item only) y ❑ 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED TYPE (For local use only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED (Check all that apply) 12 1. SPILL CONTAINMENT 1992 1. ALARM 19 9 7 RI 3. FILL TUBE SHUT OFF VALVE _4_9.92 ® 2. DROP TUBE 1 99 7 ) 2. BALL FLOAT 1992 ❑ 4. EXEMPT ® 3. STRIKER PLATE 1 992 IV, -TANK LEAK DETECTKlN IF SINGLE WALL TANK Check ad that apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): ❑ 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 2. 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) ESTIMATED QUANTITY OF SUBSTANCE REMAINING435 TANK FILLED WITH INERT MATERIAL? gallons ❑ Yes ❑ No CUPAFORM (4/99) Formerly SWRCB Form B