COMPLIANCE INFO_1986-2005 - Laserfiche WebLink

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K� + UNIFIED PROGRAM CONSOLIDATED FORM 1D TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page-of TYPE OF ACTION ❑1 NEW SITE PERMIT ❑ 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 6 TEMPORARY SITE CLOSURE (Check one item only) ❑ 7 PERMANENTLY CLOSED ON SITE DO 3 RENEWAL PERMIT (Spccify reason-for local"only) (Specifyreason-forlocdusconly) ❑ 8 TANK REMOVED 430 BUS INESS NAM E(Same asFACILITY NAME orDIJA-Doing Busines'sAs) FACILITY ID: 1 Tit— 40 0 3 4 7 LOCATIONWITHIN SITE(opts 1 431 1.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 434 005 So V ffl If"Yen".complete one(rage for each compartment. DATE INS ALL (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 /&- o v v ADDITI NAL ESCRIPTION(For local use only) 439 -u G-SW ' 1( D�✓ If.TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ❑1. MOTOR VEHICLE FUEL ❑la. REGULAR UNLEADED ❑2. LEADED [15. JET FUEL (If ttmarked complete petroleum Type) ❑Ib. PREMIUM UNLEADED 3. DIESEL 06. AVIATION FUEL Id 2. NON-FUEL PETROLEUM 13 1c. MIDGRADE UNLEADED 4. GASOHOL ❑99.OTHER ❑3. CHEMICAL PRODUCT COMMON NAME (from Haturdous Materials Inventory page) 441 CAS#(from Hawdous Materials Inventory page) 442 ❑4. HAZARDOUS WASTE (Includes UscdOil) ❑95.UNKNOWN 111. TANK CONSTRUCTION TYPE OF TANK 1. SINGLE WALL 3. SINGLE WALL WITH 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ❑95. UNKNOWN 2. DOUBLE WALL ❑4. SIGNLE WALL IN VAULT ❑99. OTHER TANK MATERIAL-primary tank U 1. BARE STEEL 3. FIBERGLASS/PLASTIC 0 5. CONCRETE 95. UNKNOWN 444 (Check one item only) ❑2. STAINLESSSTEEI. 4. STEEL CLADW/FIBERGLASS [3 8. FRP COMPTIBLE W/100%METHANOL 99.OTHER REINFORCED PLASTIC(FRP) TANK MATERIAL-secondary tank 1. BARE STEEL kr3. FIBERGLASS/PLASTIC 5. CONCRETE 95. UNKNOWN 445 (Check one item only) ❑2. STAINLESS STEEL. ❑4. STEEL.CLAD W/FIBERGLASS E38. FRP COMPTIBLE W/100%METHANOL ❑99.OTHER REINFORCED PLASTIC(FRP) ❑10.COATED STEEL ❑S. CONCRETE TANK INTERIOR LINING 1.RUBBER LINED 3.EPDXY LINING 5.GLASS LINING 0 95.UNKNOWN 446 DATE INSTALLED 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 N 3 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN 11 DATE INSTALLED 449 PROTECT'^N IF APPLICABLE PROTECTION ❑4 IMPRESSED CURRENT ❑99 OTHER (Check one item only) ❑2SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL. YEAR INSTALLED 450 TYPE(lord use only, 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all that apply) I SPILL CONTAINMENT I ALARM 43 FILL TUBE SHUT OFF VALVE ❑2 DROP TUBI 2 BAIL FLOAT ❑4 EXEMPr ❑3 STRIKER PLATE 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 (Check one item only) [31 VISUAL(EXPOSED PORTION ONLY) ❑5 MANUAL TANK GAUGING(MTG) [31 VISUAL(SINGLE WALL IN VAULT ONLY) ❑2 AUTOMATIC TANK GAUGING(ATG) ❑6 VADOSE 70NE 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 gallons ❑Yes ❑ No UPCF(12/99 revised) 10 Formerly SWRCB Form B