COMPLIANCE INFO_1998-2009 - Laserfiche WebLink

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UNIFIED PROGRAM CONSOLIDATED FOR UNDERGROUND STORAGE TANKS -TANK PAGE 1 TYPE OF ACTION ❑ 1. NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) (Check one item only) ❑ 3. RENEWAL PERMIT r-.....,... M, k -.r ou eNv) tsoecity change -for local use only) TANKS (two pages per tank) i 2. 3 ❑ 6. TEMPORARY SITE CLOSURE \\\ ❑ 7. PERMANENTLY CLOSED ON SITE O ❑ 8. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY ID • 4Ii 1 qg4 vooA Av.d L�vowd LOCATION WITHIN SITE (O 11411 431 QA /� IS 2 L r+ Q 21 Z N 20 W _i-ur4hM � A�f1 lf- I. TANK DESCRIPTION TANK ❑ Yes P9 No ` TANK MANUFACTURER COMPARTMENTALIZED T K IQ N. I 1 ' 6� If -Yes', complete one Page for each compartment. DATE INSTALLED (YEAR/MO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS (0/A 1 10 1 UO ® ADDITIONAL DESCRIPTION (Forlocal use only) II. TANK CONTENTS TANK USE 432 Iq 1. MOTOR VEHICLE FUEL �s8 PETROLEUM TYPE Ckla. REGULAR UNLEADED ❑ 2. LEADED ❑ S. JET FUEL (If marked, complete Petroleum Type) ❑ 1b. PREMIUM UNLEADED ❑ 3. DIESEL ❑ 6. AVIATION FUEL ❑ 2. NON -FUEL PETROLEUM ❑ tc. MIDGRADE UNLEAOED ❑ 4. GASOHOL ❑ 99. OTHER ❑ 3. CHEMICAL PRODUCT ❑ 4. HAZARDOUS WASTE (Includes COMMON NAME (from Hazardous Materiels Inventory page) CAS 0 (Imm Hazardous Materials Inventory page) O 010 �, n Used Oiq [195, UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK ❑ 1. SINGLE WALL ❑ 3. SINGLE WALL WITH ❑ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM EXTERIOR MEMBRANE LINER ❑ 95. UNKNOWN (Check one item only) C1 2, DOUBLE WALL ❑ 4. SINGLE WALL IN A VAULT [199. OTHER TANK MATERIAL - primary lank ❑ 1 BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ 5. CONCRETE ❑ 95. UNKNOWN _ Q L (Check one Rem 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 ❑ 8. FRP COMPATIBLE W/100% METHANOL ❑ 95. UNKNOWN (Check one item only) ❑ 2. STAINLESS STEEL 144, STEEL CLAD W/FIBERGLASS x 9. FRP NON -CORRODIBLE JACKET ❑ 99. OTHER REINFORCED PLASTIC (FRP) ❑ 10. COATED STEEL ❑ S. CONCRETE TANK INTERIOR LININGDATE INSTALLED ❑ 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING IX 95. UNKNOWN433 OR COATING ❑ 2. ALKYD LINING ❑ 4. PHENOLIC LINING ❑ 8. UNLINED ❑ 99. OTHER (For local use only) (Check one Rem on) DATE INSTALLED OTHER CORROSION ❑ 1MANUFACTURED CATHODIC ❑ 1. 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 1 YEAR INSTALLED TYPE (For local use only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED (Check aR that apply) 04 1 SPILL CONTAINMENT 1. ALARM tatL3. FILL TUBE SHUT OFF VALVE 0 2. DROP TUBE 2. BALL FLOAT ❑ 4. EXEMPT ❑ 3. STRIKER PLATE IV. TANK LEAK DETECTION IF SINGLE WALL TANK heck aA that app): 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 I PERMANENT CLOSURE IN PLACE ESTIMATED DATE UST USED (YRIMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING 435 1 TANK FILLED WITH INERT MATERIAL? gallons E]Yes ❑ No CUPAFORM (4/99) • 0 Formerly SWRCB Form B