COMPLIANCE INFO_1987-2014 - Laserfiche WebLink

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*IFIED PROGRAM CONSOLIDATED FoF* TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 11 �( O(L pages p nk) ag 1� 1'i' TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ S. CHANGE OF INFORMATION) CT@,t.TEr PRARY SITE CLOSURE (Check one item only) qq��II ❑ 7. PERtifAtYkIASED ON SITE W 3.RENEWAL PERMIT (Specify reason-for ,al use only) (Specify change-for local use only) ❑ S. TANK REMOVE''DF "430 BUSINESS NAME(S111 1 ame as FACILITY NAME or DBA•Doing Business As) FACILITY ID K 1 DAMERON HOSPITAL ASSOCIATION A000286 flT' LOCATION WITHIN SITE(Optional) 431 1.TANK DESCRIPTION TANKIDM TANK MANUFACTURER COMPARTMENTALIZED TANK C3 Yes ® No TA100203 Modern Welding Co. It'Yei,complate one page for each compartment, DATE INSTALLED(YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS 1988 6000 1 ADDITIONAL DESCRIPTION(Forlocal use only) II.TANK CONTENTS TANK USE 432 PETROLEUM TYPE C11. MOTOR VEHICLE FUEL ❑to REGULAR UNLEADED 13 2. LEADED ❑ 5. JET FUEL (it marked,complete Petroleum Type) ❑lb. PREMIUM UNLEADED ® 3. DIESEL ❑ 6. AVIATION FUEL ® 2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑ 4. GASOHOL ❑99. OTHER ❑ 3. CHEMICAL PRODUCT COMMON NAME prom Hazardous Materials Inventory page) CAS N(from Hazardous Materials Inventory page) ❑ 4. HAZARDOUS WASTE(Includes d Oil) Use KNOWN III.TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM EXTERIOR MEMBRANE LINER C395. UNKNOWN (Check one item only) ® 2. DOUBLE WALL ❑ 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 only) ❑ 2. STAINLESS STEEL ❑4. STEEL FORLA D PLASTIC(FRP) ASS ❑ 8 FRP COMPATIBLE W1100%METHANOL C199. OTHER RE N TANK MATERIAL.secondary tank ❑ 1 BARE STEEL ® 3. FIBERGLASS I PLASTIC ❑ 8. FRP COMPATIBLE W1100%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 DATE INSTALLED TANK INTERIOR LINING C31. RUBBER LINED ® 3. EPDXY LINING ❑ 5. GLASS LINING ❑95. UNKNOWN433 OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 6 UNLINED ❑99. OTHER (For loco/use only) (Check one item only) DATE INSTALLED OTHER CORROSION ❑ 1. MANUFACTURED CATHODIC M 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 434 PROTECTION IF APPLICABLE PROTECTION ❑ 4. IMPRESSED CURRENT ❑99. OTHER (For local use only) (Check one item only) ❑ 2. SACRIFICIAL ANODE SPILL AND OVERFILL /9.?.? G? YEAR INSTALLED TYPE(For local use only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED (Check all that apply) ® 1 SPILL CONTAINMENT ® 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE IV.TANK LEAK DETECTION IF SINGLE WALL TANK Check all that al:,PWs 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. CONTINUOUSATG ❑ 7. GROUNDWATER ❑ 3. MANUAL MONITORING ❑ 4. STATISTICAL INVENTORY RECONCILIATION(SIR)t ❑ 8. TANK TESTING BIENNIAL TANK TESTING - ❑99. OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITYOF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? gallons ❑Yes ❑No Formerly SWRCB Form B CLIPAFORM(4/99)