COMPLIANCE INFO_2003-2012 - Laserfiche WebLink

Home Browse Search

so, t U FIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS-TANK PAGE 1 (two pages per tank) Page_J-of TYPE OF ACTION ❑1 NEW SITE PERMIT IM 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 --==I BUSINESS NAME(same as FACILITY NAME or DBA-Doing Flus neat As) 3 FACILITY ID: 1 S.M.K. Chevron 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 sball be submitted to the local agency.) TANK ID# 43Z TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ❑Yes No 434 Xerxes U"Yes",complete one page for each compartment. DATE INSTALLED(YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 Dec 1993 12,000 one ADDITIONAL DESCRIPTION(For local use only) 438 H.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 IN 1. MOTOR VEHICLE FUEL ❑1.. REGULAR UNLEADED [12. LEADED ❑5. ITT FUEL (If marked complete Petroleum Type) [:11 b. PREMIUM UNLEADED 19 3. DIESEL ❑6. AVIATION FUEL ❑2. NON-FUEL PETROLEUM ❑1 c. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME(front Hazardous Materials Inventory page) 441 CAS#(from Hazardous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Includes used oil) Diesel fuel ❑95.UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 0 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one itrrn only) EXTERIOR MEMBRANE LINER ❑95.UNKNOWN [�2. DOUBLE WALL [:14. SIGNLE WALL IN VAULT [199.OTHER TANK MATERIAL-primary tank 1. BARE STEEL 0 3. FIBERGLASS/PLASTIC 5. CONCRETE 95.UNKNOWN 444 (Check one item only) ❑2. STAINLESS STEEL ❑4. STEEL CLAD W/FIBERGLASS ❑8. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL_secondary tank 0 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 [:199.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑5.CONCRETE TANK INTERIOR LINING L RUBBER LINED 3.EPDXY LINING 5.GLASS LINING 0 95.UNKNOWN 446 DATE INSTALLED 447 OR COATING ❑2 ALKYD LINING ❑4 PHENOLIC LINING 19 6 UNLINED ❑99 OTHER (For local (Check one item only) due only) 448 DATE INSTALLED 449 OTHER CORROSION ❑1 MANUFACTURED CATHODIC M 3 FIBERGLASS REINFORCED PLASTIC 1195 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one horn only) ❑2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE(local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all duet apply) IN 1 SPILL CONTAINMENT 1993 ❑ ALARM [W/3 FILL TUBE SHUT OFF VALVE Qq 2 DROP TUBE 2003 BALL FLOAT ❑4 EXEMPT IN 3 STRIKER PLATE 1993 2003 TV.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 (Check one item only) ❑I VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) ❑1 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE ZONE Q9 2 CONTINUOUS INTERSTITIAL MONITORING ❑3 CONTINUOUS ATG [:17 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