COMPLIANCE INFO_FILE 11 - Laserfiche WebLink

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879-G3U1 UNIFIED PROGRAM CONSOLIDATED FORM ANr81=1ZTE Z•11I.T� L� (two pages per tank) II Page I- of TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ 8. TEMPORARY SITE CLOSURE (Check one item only) 1:1x', 7. PERMANENTLY CLOSED ON SITE El 3. RENEWAL PERMIT (Specify reason- lorlocal use only) (Specify change- for local use only) ❑ S. TANK REMOVED 430 BUSINESS NAME (Sema as FACILITY NAME or DBA - Doing Business As) FACILITY 10 # 1 Lawrence Livermore National Laboratory,Site 30" LOCATION WITHIN SITE (Optona# 431 South of Building 879 1. TANK DESCRIPTION TANK ID # TANK MANUFACTURER COMPARTMENTALIZED TANK ❑ Yes No 879-G3U1 Trusco If'Yes', complete one page for each compartment. DATE INSTALLED (YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS 94/06 15000 1 ADDITIONAL DESCRIPTION (Forlocal use only) II. TANK CONTENTS TANK USE 432 PETROLEUM TYPE R3 1. MOTOR VEHICLE FUEL ❑ Ia. REGULAR UNLEADED ❑ 2. LEADED ❑ S. JET FUEL (Ir marked, complete Petroleum Type) ❑ tb. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM 0 IQ MIDGRADE UNLEADED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME (hem Hazardous Materials Inventory page) CAS # (hem Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE (Includes Used00)WN Unleaded Gasoline 8006-61-9 111. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH - ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item onry) .® 2. DOUBLE WALLEXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN ' ❑ 4. SINGLE WALL IN A VAULT ❑ 99. OTHER TANK MATERIAL - primary tank 1 BARE STEEL ❑ 3. FIBERGLASS / PLASTIC ❑ 5. CONCRETE 1195. UNKNOWN (Check one item onry) ❑ 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 IJ 3. FIBERGLASS / PLASTIC ❑ 8. FRP COMPATIBLE W/100% METHANOL 1195. UNKNOWN (Check one item onry) 112. STAINLESS STEEL 12 4. STEEL CLAD W/FIBERGLASS ❑ 9. FRP NON -CORRODIBLE JACKET ❑ 99. OTHER REINFORCED PLASTIC (FRP) ❑ to. COATED STEEL ❑ 5. CONCRETE TANK INTERIOR LINING ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING 135. GLASS LINING 1395. UNKN0WN433 DATE INSTALLED OR COATING g� 112. ALKYD LINING 114. PHENOLIC LINING 13 8. UNLINED 1199. OTHER (Check one item on) (For local use only) OTHER CORROSION PROTECTION IF APPLICABLE ❑ 1. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑ 95. UNKNOWN 434 DATE INSTALLED PROTECTION ❑ 4. IMPRESSED CURRENT 1399. OTHER (Check one item only)❑ 2, SACRIFICIAL ANODE (Forlocal use only) SPILL AND OVERFILL YEAR INSTALLED TYPE (Forlocal use only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED (Check ad that appy) 1 SPILL CONTAINMENT 1994 1. ALARM 1994 55 3. FILL TUBE SHUT OFF VALVE 19 9 4 ® 2. DROP TUBE 1994 ❑ 2. BALL FLOAT ❑ 4. EXEMPT ' 3. STRIKER PLATE 1994 •.11/u ChNktEAKDETECTIOW, IF SINGLE WALL TANK Check all that apply): IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item onl : ❑ 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 §0 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER 0'3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ❑ S. TANK TESTING BIENNIAL TANK TESTING ❑ gg, OTHER V TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YRIMO/OAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? gallons 1 ❑ Yes ❑ No CUPAFORM (4199) Formerly SWRCB Form B