COMPLIANCE INFO_FILE 11 - Laserfiche WebLink

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879-DlUl UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS -TANK PAGE 1 TANKS (two pages per tank) Page 1_ of 2 TYPE OF ACTION ❑ t. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ G. TEMPORARY SITE CLOSURE (Check one item onty) IX3. RENEWAL PERMIT ❑ 7. PERMANENTLY CLOSED ON SITE (Specify mason - forlocal use only) (Specify change - forlocal use only) 1'1 c �. - cm-. IOU BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY IDN = - t: Lawrence Livermore National Laboratory Site LOCATION WITHIN SITE (Opttonaq 431 R'3 South of Buldin 879 TANK ID # TANK MANUFACTURER I. TANK DESCRIPTION COMPARTMENTALIZED TANK ❑ Yes jP No 879-DlU1 Modern Welding Co., Inc. If *Yes', complete one page for each compartment. DATE INSTALLED (YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS 87/11 5000 1 ADDITIONAL DESCRIPTION (Forlocal use only) 11. TANK CONTENTS TANK USE 432 PETROLEUM TYPE 1. MOTOR VEHICLE FUEL ❑ Ia. REGULAR UNLEADED ❑ 2. LEADED ❑ 5. JET FUEL (If marked, complete Petroleum Type) ❑ 2. NON -FUEL PETROLEUM ❑ 1b. PREMIUM UNLEADED 0 3. DIESEL ❑ 8. AVIATION FUEL ❑ 3. CHEMICAL PRODUCT 1:1to MIDGRADE UNLEADED ❑ 4. GASOHOL 1199. OTHER ❑ 4. HAZARDOUS WASTE (Includes COMMON NAME (Nom Hazardous Materials Inventorypage) CAS # (from Hazardous Materials Inventory page) 1195 u8aKNO WN Diesel Fuel 64742-80-9 III. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM (Check one item only) 9 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ' 1196. UNKNOWN ❑ 4. SINGLE WALL IN A VAULT ❑ 99. OTHER TANK MATERIAL - primary tank 1 1 BARE STEEL ❑ 3. FIBERGLASS / PLASTIC YS ❑ 5. CONCRETE ❑ 95. UNKNOWN (Check one item only) ❑ 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 ❑ S. FRP COMPATIBLE W/100% METHANOL 1195. 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 ❑ OR COATING t. RUBBER LINED 133. EPDXY LINING 115. GLASS LINING 1195. UNKNOWN433 DATE INSTALLED (Check one item on) ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING 96. UNLINED ❑ 99. OTHER OTHER CORROSION (For/Deal use onty) PROTECTION IF APPLICABLE ❑ t. MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC 119& UNKNOWN 434 GATE INSTALLED PROTECTION 114. IMPRESSED CURRENT (Check one item only)❑ ❑ 2. SACRIFICIAL ANODE I 99. OTHER (For ocal use only) SPILL AND OVERFILL YEAR INSTALLED TYPE (For local use only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED (Check alf that apply) ® 1. SPILL CONTAINMENT 19 8 7 ® 1. ALARM 19 A 7 ❑ 3. FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT 3. STRIKER PLATE 1987 INK LEAK DETECTION IF SINGLE WALL TANK Check alt that a IF DOUBLE WALL TANK OR TANK WITH BLADDER Check one item only): ❑ I. VISUAL (EXPOSED PORTION ONLY) ❑ 5. MANUAL TANK GAUGING (MTG) ❑ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ❑ 2. AUTOMATIC TANK GAUGING (ATG) ❑ 8. VADOSE ZONE 5? 2. CONTINUOUS INTERSTITIAL MONITORING ❑ 3. CONTINUOUS ATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) a ❑ B. TANK TESTING BIENNIAL TANK TESTING 1199. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? I -gallons [ - 1 ❑ Yes ❑ No CUPAFORM (4/99) Formerly SWRCB Form B