COMPLIANCE INFO_1999-2010 - Laserfiche WebLink

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NIFIED PROGRAM CONSOLIDATEOFORM 40 TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page _ of _ TYPE 0 FACTION 1-1. NEW SITE PERMIT r 4. AMENDED PERMIT CHANGE OF INFORMATION) r 6. TEMPORARY SITE CLOSURE (Check one item only) r 7. PERMANENTLY CLOSED ON SITE r3. RENEWALPERMIT (Specify reason-for local use only) (Specify change-torlocal use only) r 8. TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3ACiLITY Ib# 1 el r\ I.., 1111,11 1111,111-1 11111 LOCATION WITHIN SITE(Optional) 431 TANK.QESGRIP;TION,(Tscaled'plotplanwit(r,thefocahlihoftheUST,sysfemincltiding:buildittgsandlartlmrkssftalfbesu6rrir(tedfvYttie%oc2Fagehcy}-, ;,,,,., TANK ICJ,#..... 432 TANK MANUFACTURER' ........ __. _. 433 __.... COMPARTMENTALIZED TANK r YesNo 434 \ (�\L�zIf AYes_ complete one page for each com artment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS vLoaNh436 NUMBER OF COMPARTMENTS 437 V ADDITIONAL DESCRIPTION(Forlocal use only) 438 �` ..,_,.r: ... � ��QNTEt��,.....a ...�... ,. ._.. .a �.: �.w:.� r. TANK USE 439 PETROLEUM TYPE 440 MOTOR VEHICLE FUEL r a. REGULAR UNLEADED 1-2. LEADED IF 5 JET FUEL //(Ifmarked,complete Petroleum Type) PREMIUM UNLEADED r 3. DIESEL r 6. AVIATION FUEL 1-2. NON-FUEL PETROLEUM r1c. MIDGRADE UNLEADED r4. GASOHOL 1['99. OTHER 1-3. CHEMICAL PRODUCT 1-4. HAZARDOUS WASTE(Includes COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 Used Oiq r95. UNKNOWN 1�{�iNIf,COSTRU� O,. TYPE OF TANK ,r,(1. SINGLE WALL 1-3. SINGLE WALL WITH r S. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) 172 DOUBLE WALL EXTERIOR MEMBRANE LINER r 95. UNKNOWN r l 1-4. SINGLE WALL IN A VAULT r99. OTHER TANK MATERIAL-primary tank r 1. BARE STEEL 73-FIBERGLASS/PLASTIC r 5. CONCRETE r 95. UNKNOVMI 444 (Check one item only) ] 2. STAINLESS STEEL 1-4. STEEL CLAD VWFIBERGLASS r S. FRP COMPATIBLE W1100%METHANOL r99. OTHER REINFORCED PLASTIC F TANK MATERIAL-secondary F 1. BARE STEEL FIBERGLASS J PLASTIC 1-8. FRP COMPATIBLE W100%METHANOL r 95. UNKNOVMI 445 tank 1-2 STAINLESS STEEL r 4. STEEL CLAD r 9. FRP NON-CORRODIBLE JACKET r99. OTHER (Check one item only) VWFIBERGLASS REINFORCED PLASTIC 1-10. COATED STEEL (FRP) IF 5. CONCRETE TANK INTERIOR LINING DATE INSTALLED 447 OR COATING r 1. RUBBER LINED r 3. EPDXY LINING r GLASS LINING r95. UNKNOVNa446 F 2 ALKYD LINING 1-4. PHENOLIC LINING UNLINED r 99. OTHER (Check one item only) (For local use only) OTHER CORROSION 1- 1. MANUFACTURED r 3. FIBERGLASS REINFORCED PLASTIC r95. UNKNOVMI 448 DATE INSTALLED PROTECTION IF APPLICABLE 449 CATHODIC (Check one item only) PROTECTION 1-4. IMPRESSED CURRENT 1-99. OTHER 1-2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED TYPE(For local use only)451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 450 (Check al/that apply) \ (� 1- t. SPILL CONTAINMENT i�-1 1. ALARM ��K3. FILL TUBE SHUT OFF VALVE 1-2. DROP TUBE v r 2. BALL FLOAT r 4. EXEMPT j r 3. STRIKER PLATE `iii •,.,,i �.� ' Vii_a' :ms's. ,�.. �^�r�#�a��'��"'�.,. IF SINGLE WALL TANK(Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER(Check one item only): 454 r 1, VISUAL(EXPOSED PORTION ONLY) r 5. MANUAL TANK GAUGING(MTG) 1- 1. VISUAL(SINGLE WALL IN VAULT ONLY) r 2. AUTOMATIC TANK GAUGING(ATG) r 6. VADOSE ZONE r 2. CONTINUOUS INTERSTITIAL MONITORING r 3. CONTINUOUS ATG r 7. GROUNDWATER 1-3. MANUAL MONITORING r 4. STATISTICAL INVENTORY RECONCILIATION(SIR)+ r 8. TANKTESTING DICAINHAI,TAh1te TFCTIAI(_ a V ANI3CLpSU)2 INFO(2IVIATIQLV PEEIHbP1EN T C~QSL)RE ItJ'1? At;� . . .', ESTIMATED DATE LAST USED(YR/MO/DAY) 455 TED QUANTITY OF S'!UBS* gal 4,57 gallons ryes rNo