COMPLIANCE INFO_2011-2018 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(Once o".' p&OS15- TYPE OF ACTION (Check one item only. For-uAJST panumut clognpa or removal,complete only this section and=ections 1,11,M IV,and IX below) 430 0 1.14EV PERMIT 3 RENEWAL PERMIT E3 5.CHANGE OF INFORMATION El 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE 8.UST REMOVAL -DATE tin 43M DATE EXISTING UST DISCOVERED. L Tk FACILITY ID#(Agency Use 0*) 71 ,1 I 7T7 BUS ameasFACILITYNAMEorDBA-Dol B As' 3 US JU3 Cr,-jy 1041 -'2 T -TON V TAM M# 42 TANK MANUFACTURER 433 TANK COMOMTION:THIS TANKS 434 -L Q 1.A STAND-AIDNE TANK &=Z.A COMPARTMENTED LTfGT. fbreachocumamnentintbeard. DATE UST S S IN TALLED 43STANK CAPACrLY IN GALLONS 436 NUMBER OFCOMPARTMENTS IN THE UNIT 437 TANK USE Ia.MOTOR VEHICLE FUELING [I lb.MARINA FUELING 0 lc.AVIATION FUELING 439 3.CHEMICAL PRODUCT STORAGE [3 4.HAZARDOUS WASTE(lndWa U 09) 0 5.EMERGENCY GENERATOR FUEL DW 12528 13 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN [3 99.OTHER(Specify): 439a CONTENTS PETROLEUM: ;gja-REGULAR UNLEADED [3 ]c.mmGRADEUNLEADED 0 lb.PREMIUM UNLEADED 4411 C]3.DIESEL E3 5.JET FUEL E3 6.AVIATION GAS [3 &PETROLEUM BLEND FUEL Q 9.OTHER PETROLEUM (Specft 440a NON-PETROLEUM.[3 7.USED OIL- 0 10.ETHANOL 11.OTHER NON-PETROLEUM m r LON TYPE OF TANK 1.SINGLEWALL 2.DOUBLE WALL 95.UNKNOWN 443 PRIMARY CONTADqhffi'NT MI.STEEL 'r-I %-FIBERGLASS 6 INTERNAL BLADDER 414 Q 7.STEEL+INTERN RING ❑95.UNKNOWN OTHER 444a I SECONDARY CONTAINMENT ❑rl I-STEEL 3.FI'MBERGLASS LJ 6.EXTERIOR MEMBRANE LINER LJ?7 MJACK:ETED, 445 13 NONE 2 _ ❑ 95.UNKNOWN 0 99.07HER ERE!%): 445a I.kUD a VIS]A -=2.B OVERFILL PREVENTION AUDIBLE REQUIREMENTS ALARMS BALL FLOAT e)Q 3.FILL TUBE SHUT-OFF VALVE 452. 0-4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILC PREVENTION EQUIPME-IT PROIN. A T. ,M4.0, PIPING CONSTRUCMON ❑iSINGLE-WALLED X]2.DOUBLE-WALLED Q 99i OTHER 46D SYSTEM TYPE i.PRESSURE 2.'GRAVITY 3.CONVENTIONAL SUCTION Q 4.SAFE SUCTION[23 CCR§263-6(aX3)) 458 PRIMARY CONTAINMENT ❑ 1.STEEL 4.FIBERGLASS a.FLEXIBLE 0 10.RIGID PLASTIC 4111 ❑ 90.NONE 95.UNKNOWN [3 99.OTHER(Specify): 4Ma SECONDARY CONTAINMENT [3 1.STEEL *.FIBERGLASS ❑s.FLEXIBLE ❑ 10.RIGIDPLASTIC 4MI I EJ.4 13 90.NONE %95.UNKNOWN [3".OTHER(SPW*): 464 1 ;:� PIPING/TURBINE CONTAINMENT SUMP TYPE I-SINGLEWALL Q 2.DOUBLE WALL 90.NONE 4644 Lj 1.STEEL VENT PRIMARY CONTAINMENT 4.FIBERGLASS 0 10.RIGID PLASTIC qTjc r 1 90.NONE El99.OTHER(Specify) 464* 4641 VENT SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS [1 10.RIGID PLASTIC )(go.NONE [3 99.OTHER(specify) 464f 4641 VR PRIMARY CONTAINMENT 0 1.STEEL � 4.FIBERGLASS 0 10.RIGID PLASTIC 0 90.-NONE 13 99 OTHER(Spm*) 464a 464s] VR SECONDARY CONTAINMENT 0 1.STEEL 0 4.FIBERGLASS [1 10.RIGID PLASTIC90.NONE IJ 99.VffffR-(Specify) 4646 i VENT PIPING TRANSITION SUMP TYPE�1.SINGLE WALL 0 2.DOUBLE WALL k 464hI -5r90.NONE 4645. RISER PRIMARY CONTAINMENT 1.STEEL4.FIBERGLASS Ll 10.RIGID PLASTIC 0-90.NONE 0 99.OTHER(Specify) 464j 464j] RISER SECONDARY CONTAINMENT E3 1.STEEL 4.FIBERGLASS [3 JO.RIGID PLASTIC0.NONE El 99.OTHER(Specify) 464k 1 V9 464k1 FILL COMPONENTS INSTALLED 5;ki.SPILL BUCKET IF13.STRIKER PLATEIBOTIDm PROTECTOR 1:1-4.CONTAINN[ENTSUMP 451a-c CONSTRUCTION TYPE N-LSINGLE WALL E3 2.DOUBLE WALL [3 3.NODISPENSERS 469a ..CONSTRUCTION MATERIAL -1.STEEL. 4.FIBERGLASS 10.RIGID PLASTIC 13 469bc '40 VUL.,G, M 0 ,,PR,37% STEEL COMPONENT PROTECTION 0 2.SACRIFICIAL ANODE(S) E3 4.PAPREssED CURRENT 16.ISOLATION 448. .rTEETL CERTEWAUQN-6 I certifythatthis UST system is compatible with the hazardous substance stored and that the Information pro true,a .Aand!L&B Como ce with legal requirements. CA" DATE APPLWVVMME hri4 471' APPLICANT TMP 0,) UPCF USTW-1/2 Rev.(1212007)