COMPLIANCE INFO_1987-2002 - Laserfiche WebLink

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�IFIED PROGRAM CONSOLIDATED FOS q:) fly TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Pow-Of TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Cheek one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Spoaty reason-for local use only) (Spealy reason-for local use only) ❑ 8 TANK REMOVED 430 BU NESS NAME(Same as FACILITY NAME or ORA-Doing Business As) FACILITY ID: 1 / 3 e LOCATION WITHIN SITE(optional) 431 L TANK DESCRIIPTI1 W(Ast;aW,pkat pWn whh the Wcation of the UST system intdudit build fts.and WWWnaft shay be a TANK ID# 7T5- 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK-0 Yes 16 -. NO 434 3,7000d_3 l A0Ax.,0 W a-a j-1 If'Yes'.complete one page for each convarbraft DATE INSTALLE (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 3 in /A 000 ADDITIONAL DESCRIPTION(For local use only) 436 IL TANK COMM TANK USE 439 PETROLEUM TYPE 440 2(1. MOTOR VEHICLE FUEL P1 1a. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked complete Petroleum Type) ❑1b. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory pope) 442 ❑4. HAZARDOUS WASTE (Includes Used Oil) ❑95.UNKNOWN 671SO/i004� 0L-,0 q Ig. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL C3 3.SINGLE WALL WITH 4. SINGLL'NA11 `KITH INTERNAL BL°,DDER SYCTEki 443 i . ..-:.x r _ .. tX rt�a:tnc n� ft,1�:"'" .r_ - ❑ ,a.. -. ...:iJ 2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULI- [199. OTHER TANK MATERIAL-pnmary tank 1. BARE STEEL [73. FIBERGLASS/PLASTIC 0 5. CONCRETE 0 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL X4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPATIBLE W/ ❑99.OTHER REINFORCED PLASTIC(FRP) 100%METHANOL TANK MATERIAL-secondary tank 1. BARE STEEL Ej 3. FIBERGLASS/PLASTIC [15. CONCRETE C3 95. UNKNOWN 445 i (Check one item only) ❑2. STAINLESS STEEL [14.STEEL CLAD W/FIBERGLASS [18. FRP COMPATIBLE ❑99.OTHER REINFORCED PLASTIC(FRP) W/100%METHANOL ❑5. CONCRETE ❑10.COATED STEEL TANK INTERIOR LINING ❑1.RUBBER LINED ❑3.EPDXY LINING 05.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLEC 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING ❑6 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION ❑1 MANUFACTURED CATHODIC[j3 FIBERGLASS REINFORCED PLASTIC ot 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED IWf 452 (Check all Of 1 SPILL CONTAINMENT 1 ja j that apply) ❑1 ALARM ❑3 FILL TUBE SHUT OFF VALVE Ed 2 DROP TUBE flo %2 BALL FLOAT ❑4 EXEMPT 3 STRIKER PLATE /fi IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the loo agency.) IF SINGLE WALL TANK(Cheek all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (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 rK 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG ❑7 GROUNDWATER ❑3 MANUAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑8 TANK TESTING +(SIR) BIENNIAL TANK TESTING ❑99 OTHER IV.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 TANK FILLED WITH INERT MATERIAL? 457 REMAINING gallons ❑Yes ❑ No UPCF (1/99 revised) Formerly SWRCB Form B