COMPLIANCE INFO_2003-2012 - Laserfiche WebLink

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4AML O!> b LI FIED PROGRAM CONSOLIDATED FORM 6 1i�1p3 TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (two pages per tank) Page__j of 2 TYPE OF ACTION ❑1 NEW SITE PERMIT 1M 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason-for local use only) ❑ 8 TANK REMOVED 430 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) FACILITY ID: 1 S.M.K. Chevron 3 LOCATION WITHIN SITE(optional) 431 North of canopy 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# 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes No 434 Xerxes If"Yes",complete one page for each compartment. DATE IN TALLE (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 Dec 1993 12,000 one ADDITIONAL DESCRIPTION(For local use only) 438 IL TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 1. MOTOR VEHICLE FUEL 125 1. REGULAR UNLEADED ❑2. LEADED ❑5. JET FUEL (If marked complete Petroleum Type) ❑I b. PREMIUM UNLEADED [13. DIESEL ❑6.AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1 c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME(from Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials inventory page) 442 [:14. HAZARDOUS WASTE (Includes used Oil) Reqular Unleaded 800-61-9 ❑95.UNKNOWN M. TANK CONSTRUCTION TYPE OF TANK El 1. SINGLE WALL Ll 3.SINGLE WALL WITH Ll 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one irmt only) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN (5 2. DOUBLE WALL ❑4.SIGNLE WALL IN VAULT ❑99.OTHER TANK MATERIAL-primary tank 0 1. BARE STEEL 95 3. FIBERGLASS/PLASTIC 0 5.CONCRETE 0 95.UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS [18.FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank 1. BARE STEEL 19 3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN 445 (Check one item only) [12. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS C18. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) [110.COATED STEEL ❑5. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED ❑3.EPDXY LINING 5.GLASS LWING 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING IO 6 UNLINED ❑99 OTHER (Check one item only) (For local use only) OTHER CORROSION C]I MANUFACTURED CATHODIC N 3 FIBERGLASS REINFORCED PLASTIC C195 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2 SACRIFICIAL ANODE (For 1=1 use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) Q9I SPI L CONTAINMENT 1993 ®1 ALARM ❑3 FILL TUBE SHUT OFF VALVE 29 2 DROP TUBE 2003 IN 2 BALL FLOAT ❑4 EXEMPT 29 3 STRIKER PLATE 1993 2003 IV.TANK LEAK DETECTION(A description of the monitoring pmgrmn 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 (Cho&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 09 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 REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 n/a n/a gallons n/a ❑Yes ❑ No UPCF(12/99 revised) 10 Formerly SWRCB Form B