COMPLIANCE INFO_1986-2005 - Laserfiche WebLink

Home Browse Search

IED PROGRAM CONSOLIDATED FORM -Z TANK: TA0141302 7 PR#: PR0231413 UNDERGROUND STORAGE TANKS -TANK PAG /, FAC#: FA0003122 ( j j,��% (two pages per tank) TYPE OF ACTION ❑ I NEW SITE PERMIT ❑4 AMENDED PERMITPage 4 of 7 (Check only item only) ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT ❑8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME m DBA-Doing Business As) FACILITY ID: PR#: T-17 � I I I I QUIK STOP MARKETS 138 3 FA0003122 PR0231413 LOCATION WITHIN SITE(Optional) 1153 LINCOLN BLVD,TRACY 431 PHONE g ��8� tf I.TANK DESCRIPTION(A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID# Tank#: 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes [t?No 434 TA0141302 X LL X Ae S If"Ya",complete one pagc Cor tach compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 1/1/1986 10,000 `1r ADDITIONAL DESCRIPTION(Fm lowt use only) 438 II.TANK CONTENTS TANK USE 439 PETROLEUM TYPE ® 440 1.MOTOR VEHICLE FUEL ❑ la.REGULAR UNLEADED ❑ 2.LEADED ❑ 5.JET FUEL (If marked complete Petroleum Type) ❑ Ib.PREMIUM UNLEADED ❑ 3.DIESEL ❑ 6.AVIATION FUEL ❑ 2.NON-FUEL PETROLEUM ® lc.MIDGRADE UNLEADED ❑4.GASOHOL ❑99.OTHER ❑ 3.CHEMICAL PRODUCT COMMON NAME from Hazardous Materials Inventory ry page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑ 4.HAZARDOUS WASTE �fj� �`� I (Includes Used Oil) ��//► ('may \ ❑ 95.UNKNOWN jkz C IC r2.'r'�fti.t �S -I dd q.�4" 1 � In r M.TANK CONSTRUCTION TYPE OF TANK ❑ I.SINGLE WALL ❑ 3.SINGLE WALL WITH ❑ 5.SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Chock one item only) EXTERIOR MEMBRANE LINER ❑ 95.UNKNOWN ®2.DOUBLE WALL ❑4.SINGLE WALL IN VAULT ❑ 99.OTHER TANK MATERIAL-primary tank ❑ 1.BARE STEEL ❑ FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 444 (Check one item only) ❑ 2.STAINLESS STEEL ❑ STEEL CLAD W/FIBERGLASS Rr8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 99.OTHER TANK MATERIAL-secondary tank ❑ 1.BARE STEEL ❑ 3.FIBERGLASS/PLASTIC ❑ 5.CONCRETE ❑ 95.UNKNOWN 445 (Check one item only) ❑ 2.STAINLESS STEEL ❑ 4.STEEL CLAD W/FIBERGLASS { 8.FRP COMPTIBLE W/100%METHANOL REINFORCED PLASTIC(FRP) ❑ 10.COATED STEEL ❑ 99.OTHER ❑ 5.CONCRETE TANK INTERIOR LINING ❑ 447 1.RUBBER LINED OR COATING ❑ 3.EPDXY LINING ❑ 5.GLASS LINING ❑95.UNKNOWN 446 DATE INSTALLED (Check one item only) ❑ 2 ALKYD LINING ❑ 4 PHENOLIC LINING R 6 UNLINED ❑ 99.OTHER (For local use only) OTHER CORROSION ❑ I MANUFACTURING CATHODIC ❑ 3 FIBERGLASS REINFORCED PLASTIC95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑ 4IMPRESSED CURRENT 99 OTHER (Check one item only) 2 SACRIFICIAL ANODE ❑ ❑ (For local use only) SPILL AND OVERFILL YEAR INSTALLE450 TYPE(local useonly) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Chink all that apply) [ 11 SPILL CONTAINMENT /C/ 6 ❑ I ALARM [j(3 FILL TUBE SHUT OFF VAL` [1Er2 DROP TUBE f E]�/ 2 BALL ❑4 EXEMPT LSI 3 STRIKER PLATE _L7 FLOAT IV.TANK LEAK DETECTION(A description of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK(Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 ❑ I VISUAL(EXPOSED PORTION ONLY) ❑ 5 MANUAL TANK GAUGING(MTG) (Chock one item only) ❑ 2 AUTOMATIC TANK GAUGING(ATG) ❑ 6 VADOSE ZONE ❑ 1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑ 3 CONTINUOUS ATG ❑ 7 GROUNDWATER ®2 CONTINUOUS INTERSTITIAL MONITORING ❑4 STATISTICAL INVENTORY RECONCILIATION ❑ 8 TANK TESTING (SIR)BIENNIAL TANK TESTING ❑3 MANUAL MONITORING ❑ 99 OTHER V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED(YR/MO/DAY) 455 1 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ❑Yes ❑No UPCF(12/99 revised)