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HomeMy WebLinkAboutUNDERGROUND TANK-C-03/28/89 FACILITY: ADDRESS : PERMIT #: · ." FILE CONTENTS SUMMARY ENV. SENSITIVITY:, Activity Date # Of Tanks Comments 2700 'M' Street. St:e. 300 Bakersfield, CA 93301 (805) 861-3636 ; .[ E~,..ronnent~l Health Services De' ......................... :-Office of the Architect ............................ P,O. Box 1079 Sacramento, CA 95812 " RE: 1000 gallon gasoline tank located nt Department of TransportatiOn Owens Street Facility Dear Sir: This is to advise you that this Department has reviewed the project results for the subsurface investigation conducted at Department' of Transportation, 1716 Owens St., Bakersfield, California, closure permit #A834-13. Based upon the findings, this Department is satisfied that the assessment is complete and no soil contamination resulted from the gasoline tank at the site. Thank you for your cooperation in this matter. DS:dr dan~A834-13.1tr Sincerely, Dan' Starkey, REHS .,. ! Environmental Health Specialist I Hazardous Materials Management Program Alpha VAnalytical Laboratories Inc. · · 860 Waugh Lane, H-l,. Ukiah, California 95482 (707) 468-0401 CHEMICAL EXAMINATION REPORT Kern County Health Department 1700 Flower Street Kern, CA 93305 Attn: Joe canas Page Date Sampled: ,~%/!3~89 1 Time Sampled: 14:30 Sampled By: Al-Oesterling Date in Lab: '0~-~/!~/89 Sample Type: Soil Sample 1 ~ethod ResuLts ~t~'~hct' 10' rests '-- ............................ ' ..................... "' .................... ....... 1716 Owen Street Tank # 1 2' Center North TPH - Gasoline Benzene Toluene Xylenes Ethylbenzene LUFT ND EPA 8020 ND EPA 8020 ND EPA 8020 ND EPA 8020 ND ug/g 1 ug/g .3' ug/g .3 ug/g .' .3 ug/g .3 MDL - Minimum Detection Limit ND None Detected NOTES: ~': Bruce L. Gove C~Lt ! Laboratory Director ate Printed: 01/26/89 Alpha Analytical Laboratories Inc. 'o ,~ 860 Waugh Lane, H-l,, Ukiah, California 95482 ,. (707) 468-0401 CHEMICAL EXAMINATION REPORT Kern County Health Department Date Sampled: 1700 Flower Street Time Sampled: Kern, CA 93305i Sampled By: Attn:~'Joe Canas Date in Lab: ~ Sample Type: Page 01!/-13/89 2 14:45 A10esterl ing ......... : ................................. = ............... Her hod. ........................ Resu [.ts ........ --? ,. Unit s .......... *, .MOL Batch 89-0117-012 consisted of 2 SampLes and lO.Tests Sample 2 1716 Owen Street Tank # 1 : 6' Center North TPH - Gasoline Benzene Toluene Xylenes Ethylbenzene LUFT ND 'ug/g 1 EPA 8020 ND ug/g .3 EPA 8020 ND ug/g .3 EPA 8020 ND ug/g .3 EPA 8020 ND ug/g .3 MDL - Minimum Detection Limit ND None Detected NOTES: Bruce L. Gove Laboratory Director a~te P~/r ~nted: 01/26/89 Alpha ~Analvt~cal La~0ratones Iiii~ .......· i!i6~' tNa[~'t~ l~i~, ~'-t, ~J~iah, California 95489- . . (707) 468.0~1 FAX COVER SHEET pLEASE DELIVER LLOWING S TO: ~i ............. Jan£ce Leman .._ 805- ~2 4-1715 NAME: LOCATION: Ker~ County Enviror~ental Health TOTAL ~ OF PAGES: 2 (INCLUDING COVER SHEET) NARD COPY TO POLLOW · DATE: 1-10- 89 FROM: L6ri X NO THANK YOU: LO.~ ~moM~m .- ........ FAX ~, 916-652-9624 Division of E~vironm~nta~eal~- 1700 ~lower St. .~ ..... .-- " B~ field, ~. 93305 ....... ....... - .... ,.-. ~e~ .I' ob~n th'e s~le I ask ~e backhoe operator...to scoop a bucket of native soil fr~ each ~le location=--~.~a~L-i%-~ ~as been de~cted, .._ ' I hope I have coV~d th~ area you ace inquirfn~ a~out. If' not, please' let ~ know as soon as possible as 'rotator Tra'ctor iS h~ing to have CT;It ~~.~, I "Placer'r'ra~tor Service ~,.~'~ ~:..~ ?200 W~lls Avenue ~~ . ': Loomis, California 95650 Contractors License ~40591 A. General Engineering B. 1 General 8uilcling DOH Hauler,~350 C. 2 Insulation · C- 10 Electrical PUC #152608 PLEASE DELTVER FOLLOWING PAGES~: ^ TOTAL # 'OF PAGES: ~ ~ ~PY ~ FOL~W ~S .-- FAX COVER SHEET (INCLUDING COVER SHEET) IF YOU DO NOT ~ECEIVE ALL T~IE PAGES, PLEASZ CALL AS SOON AS POSSIBLE SO WE MAY ~S~ND THIS FAX. 916-652~9624 ~~~e%aPh~a '~"AnT~ Laborato6,es' [n~'. ..... ~-: .... k0 Waa~h Lane, H-I,"Uki,{h, 'C~if~rnia b5482 January 9, 1989 Kern Cfunty Health Department.. '- Dividion of EnvirOnmental 'H~aIth .... Attn: Janice.~em~ ..... ~- . ~.' ...... ~.. .......... When we last spoke on the phone earlier today, 'you requested luther details on how w~ retrieved our soil .... ~or. a one thousand ~all'on fuel tank we ask the hoe op~rat, or to go two feet below the tank in the center and' then' again-at 'six 7f~"~-"the center. The equipment oDerator is then asked to retrieve a bucket full of soil as requeste~-by the county ~nspector':.- ~h~'-coUnty inspector .make~'the decision as to which bucket of s6iI he wants analyzed. ' ..... Once that decisi~' ~s been made the top inc~ of so~,l-w~-_%~ ~b~-~emoved and a soil t~b'e ~'s"in'~err~d~ -The tube will then be covered with..foi!.,_.capped aha then taP.~'d-~-ffl ".L2 ....... ' .......... '~f- y~u have any~/-?ae~t~ons reh'~ding o~r 9roce'du~s'-f-e~-l- ~ree to call' ~, ~lacer Tractor'Service 7200 Wells Avenue ~.oomts, California 95650 · (916) 652:5535 EPA ~/CAD 952040206 A. General Engineering DOH Hau!er ~2350 -' Contractors License t~t4~0591 ..~ FAX COVER SHEET ,PLEASE D. ELIVER FOr.LOWING pAGES TO: ~TION: ~~ ENVIRONMENTAL HEALTI- __(INCLUDING COVER SHEET) __~ No TOTAL # OF PAC~E$: ___ ~ ! HARD COPY TO FOLLow _.____~$. FROM: p IF YOU DO NOT RE~!V'E ALL THE PA~$, PLEASE cALL AS SCaN AS PC, SSI~.~~. SO W1~ MAY P~SEND ~H!S P~. FAX #: 916-652-9624 ~,~ I=r~c ~ 0 F"q',i'~ C ;ERTl FICATF OF INSURANCE All California Flaber Tractor Service Operations ' - ,. : ['.o,..,. ....... ' .... '" ~NKRA~ ~IABi~i~Y A . . .  OP~N~TIONi · VNO~N~NO~ND ~""'"""''" CIF 092232008 6-9-89 eo..,..o , 1,000 ~ 1,00~ auVo~oa,~ ~teud-, or relier ~ G0ver~ ~Eo=~ ::::::::::::::::::::::: ~,Aa,~VV ~ ~e ~OlICE.. ,:.~..........,........ ~;~ "':':':':':':':':':':" ,I-i.~v~ io~ ,.~u.~ ....:.'.:.'.:.'.'.'.'.'.'.'.......~.....~... {e~N p~N~o~) ~ [00 ::::::::::::::::::::::: ::::::::::::::::::::::: . , (,ACH oeeu...e~) ~ 300 .,...'.-.~'.~'... B ~.~:.~:.:.;.:::::.:, ..... GO M I I N · b S .:.:.:,;,:...:.:...-,,.. · XC~S LIABI~iTY - wo~R~. :::::::::::::::::::::::::::::::::::::::::::::::::::::, , ,., , ,. · · ,-,- . - · . . :::::::::::::::::::::::::::::::::::::::::::::::::::: ,~ ~ ~ ~..-. ~ ~ -,-/,-/,,,,.,,,.,,,:,:,,*,,~,:,,-,,,-:,:,.,. (lAC ADDITIONAL PROVISIONS ~u~, dam~, or Io~, i~luding any deem, arising out of or ~nn~ wi~ [he w~k under this ~e Insurer ~all ~t ~n~i or ~di~ th~s ~1;~ wi~out ~ving tht~y (~) da~ prior ~i~n ,oti~ to the Stere ~ Contr~ Manhunt ~on, P,O. Box 1079, Sa~nto. ~liforni~ S~e ~all not ~ r~ible ~cr any ~emicms or ~ment~ on ~he USF&G !1-16-88 Contractors Licens~ ,~4059i EPA/~3AD 982,~40206 A- General En.cjineering @ .- 1 General Placer TraCtor Service:f l (' Loomi$, California 95650 ~ ~.. - .....;'"' ~ -;~ ,~ (916) 652-5535 DOH Hauler.~350 C - ~ Insuiation C. I0 Eiectdcat PUC ¢152608 PROCEDURES FOR SOIL S}3!PLING chest containing dz~, ice. T]ie samsle is im=ediateiv Feder~i Expressed ~ ' to Alpha -~.~!ytica! in Ukiah (Certificate ~]24) - ; · , Results are available within 5 workin,3' days [for usual TPH, and BTX & E). See attached for recofmmendei soil sa/m.;les. _UNDERGROUND TANK HYDROCARBQN.-./~A~ ~Q~~ Unknown Fuel .................. ~-~ ........... TPH G GcFiD(5030) BTXiE 8020 or.a240 ade~ TPN G GCFID(5030) ..~ BTX&E 8020 .or~8240 .~ Optional--- .>r~ TEL DIiS-LUFT EDB DHS-AB1803 ~5_T_ER_ A~;ALYS I S, TPH G GCFID (5030) - T?H-" D ........... (~oni.ca ti'~n-) ............... ~-~- BTX&E 602 or 624 TPH G GCFID(5030). BTX&E 602 or 624 TEL DMS-LUFT EDB DHS-AB1803 · _Un 1 e,~.da_d__Gas TPH G BTX&E Diesel TPH D BTX&E rJet Fugl TPH D BTX&E GCFID(5030) 8020 or 8240 '(sonicatton) 8020 or 8249 GCFID(50. O, 8020 or' 8240 TPIi G GCFID(.5030) BTX&E 602 or 624 TPH D (sonication) BTX&E 602 or 624 TPH D GCFID(5030) BTX&E 602 or 624 ~erosene TPH D BTX&E GCFID(5030) 8020 or 8240 TPH D GCFID(5030) BTX&E 602 or 624 ~.Del Oil TFH D BTX&E Chloriru~ted.'$olven~s CL HC BTX&E GCFID (5030). 8020 or 8240 8010 or B240 ~020 or 8240 TPH D GCFID(5030) BTX&E 602 or 624 CL RC 601 or 624 BTX&E. 602 or 624 ~_n _Chlorinated Solvep~$ Waste 0i~ or_Unknown TP}{ O TPH G&D BTX&E GCFID(5030) TPH D GCFID(5030) 8020 or 8246 B~-A&E 60'2 or 624 GCFID(5030~ TPH G&D GCFID(5030) 5030~E 0 & G 603A~E 8020 or Blqf3 BT~&~ 602 or 624 CL NC 8010 or 8240 CL ItC 60i or 624 'ICAP or AA TO DETECT ~ETAL$: Cd, Cr, Pb, Zn METHOD 8270 FOR SOiL OK WATER TO DETECT: PCB* PCB* PCP* PCP*' PNA PNA CREOSOTE CREOSOTE *If found, analyze for.dibenzofuranm (PCBs) or dioxins (Pcp) NOTA BENE: GCMS'using Focused Cryogenic procedures may-be. ~ubstituted for BTX&E,TPH or chlorinated hydrocarbon analyses. Method 5030 is a purge and tr~p ~eparation for analysis. ' ' "/ ' ' {ECORO ~ · ,',' T'I IqE CONTAHI NAN'I Rellr~cluished by: ($igneture) Date / Time Received by: I$ona*utel4 te/Time Re . ;~n, rut*l Da~t.e/Time Received by: ISi~n~u,el RelinqUished by: t$,~l,,atutel Date / Time.., Received lot Laboratory by: Date ~me Remarks '!,~ i - '"' ' ' ''/'''' ':'' JAN 5 0.1080KERN COUNTY HEALTH Bakersfield, California 93305 DEPAR~ME~ HEALTH OFFICER Leon M Hebertson, M.D. Telephone (805)861-3636 .' ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL He,iTl-' ~\ =,.Ecro.,, VernoltOF ENVIRONMENTAL$. Relchard HEALTH Facility Name ~_/~,/ . _'- Kern County Permit # . .".* * UNDERGROUND TANK DISPOSITION TRACKING RECORD * * This form Is to be returned to the Kern County Health Department within 14 ~ of acceptance of tank(s) blt disposal or. recycling facility. The -. · . .: :u. that this form is completed and returned."- ' "- ' '.' · Tank Removal-Contractor:/lr, Z~f'I~'G~"+O~2' Secb?;c.~ Date Tanks Removed'-~TQ~ /~'~ "w/73¢ No. of Tanks / Section 2 - To be filled out by contractor "decontamlnatln~ tank(s): -, · UL~Authorl'zed representative of contractor certifies by signing below that .. ;3~:tlnk{~.} "have been decontaminated In accordance ~tth Kern County itealth ~ Signature Title 8~tto~ $ -T~ b~ filled out and ~l~ned '~ a~ authorized rep~e~eatattve-of the treagment, storage, o~ disposal .faclltt~ acce~tln~ tank(.s): Oelano . [.~mont ' ~ke Isabella . Mojave . Ridgecrest $hafter . Taft 2700 I~ Street ; Bakersfield, California KERN Mailing Address: ,' 1415 Truxtun Avenue · Bake.field, California 93301..... PE~IT FOR PE~ENT CLOSURE ..,:'i'SUBSTANCES HEALTH OFFICER .eon M Hebertson, M.D. R OF ENVIRONMENTAL HEALTH Vernon S. Reichard NUMBER A834-13 · , 16)=32 26 ;C?,:. ~ _ , _ ;,;.~*?,.,- ...... ~..~.:.,,.~,:~,f.~::~...s,~:~,:. o,.'~. - ..---' ;~c*--" ,%.,J.~s~4~,~:-,~,,~' '~ ,'-- '*.'*, ............ ,?~:~;~,?,~F.~-~;~,~.-'- :~'~'*:;~:'~'~;'4~'~'?~i~J~;~d~;~;~' 1 TANK(S)-':'~T ~BOVE - '.' ' :: APPROV~ DATE .... ' ...... '" ....January 9, '~1989 ': ~OCATION J:.;,J':;~:.'<: _ . ,~,.~.~.:¥ .~.::-~,,':~:.:%~.~ ?APPROVED BY,.4< ~/:. ~ '- . ': ....... :.;,'..F~,~ -: ': ,& .......... ',... ~ :, :;~ .... ': .: .... -.~,.:, ~.,~,':, ,, ~..-.~;.. /} . Janls Lehman ,<:-.'.:. :; - ' 4- - ;.7:~' ", :~; - · ',:'?':'* .L - .............. ' .................... ~..:'....". POST ON. PR~XS~S ............................. :' - ', ' ..- - . .- .' ' ..... . ,.*r ' -': *' ~" ' .~.: - ~ - ~- : .":'c:-*. '%:':::,~' -. : ~ ..... ..%.?It is the responsibilit~"bf ~the-Permit'tee ~o obtain permits which may:be .... .required by o~her regulatory agencies pr,lot to beginning wor~,:~:incl~ding ...... ..any Air Pollution Control Permits..:~'-:..'::.::,.J..- .:%;::-.,,..,~:~:.,--- .; -"'. 2 .... Permi~ee must Obtain a City F1,~ ~epartmen~ permit prior ~o' '~ "' :"?' (-closure ac~ion."~.~:~t-~C~4:,~}:~?~k~?~.~'.::2~&~(.~]?,~99.~??%~/'.' , .' '..].?~"~?:"-"..~,--: .: ":"3. '~q':~,:':"" Tank Closure actiV~'~:es'm~'~"~e"~'~"Kern "county Health and Pire Department approved methods as described 'in Handbook UT-30 ~:.~ -'~::~,"-': · ......... Any deviation f~o~ Sample locations and numbers or constituents 't© be . .sa~ple~ for ~hich are describe~ belo~ and in EandbooA UT:30 must receive ....~,:.;...,.~:::~.:..4prior approval by the Health Department. · ..... -' '--', · ?.~',~:~::: a...[.?~:_(TanA size 1,.000 gallons or less).:~[a ~inimu~ of ~t.o ~amples must'~be -"-.-'-----"::--::-'*.~,~.-~etrieved beneath the cente~ of the 'tan~ at depths of - " two feet and si~ feet..':- i~:-~ ..... : .... , ..... L. ~ . -:. -- 5. '-' ~f any cont~actors, o~ dispos~l facilities other than those listed on permit and permit application are ~o be utilized, prior approval must be granted .............................. ~.y__the spec!alis~, listed on the permit, ~ ' :/. - 6, Soil Sampling (piping area) a minimum of two samples must be retrieved at depths of approximately two feet and six feet for. every 15 1-inear feet of pipe ru~ and also near the ~ dispenser . area(s) , OF UNDERGROUND HAZAI~OUS ,~. ADDENDUM ' SUBSTANCES STORAGE FACILITY .i <.,~(.~..~}./~.:}...~?,:}~.: a. ,~ ~All (leaded/unleaded) gasoline samples must be analyzed .for benzene ..... ~?~toluene, xylene, 'and total petroleum hydrocarbons. : · '?--'8.h,.:~}~?:~'~".Cog~tes 0f .... .transportation 'manifests /must "-be ,submitted ~;:to ':~-:.;~:<~:..~,~?'~5~}}['xor t~eatment must be adhered to .' .::;' The Kern County, 'Health 'Department:;must. 5}'~?~;~)~::~}~,be notified before' moving and/or'dis osin 0f~'an Contaminated"soiI~?~:~i~ ~?~(}~i,O.;:~;?~....'Permittee is .responsible for making sure that ?.tank d~spos~tion'.,.t~ack~ng !1 '<,.~>::Advise this office of 'the time and 'date 0f .the proposed sampling wi~h:.2~ o:q~':12.:'.~%;'::Results must be submitted to this ,office within ~,three days of ::~analys~s ACCEPTED BY: DA ' JL:cd DIVISIO~ OF ENVIRONMENTAL H~ALTH ~ . ....... ~pp LICATIOH 1'/00 FLOWER STREET. BAKERSFIELD. CA 93305 ~ 01~ TANKS TO BE A~N~D (805) 861-3636 · ~__ ~ .,~GTH OF PIPIN~ APPL2CATION FOR. PERMIT FOR PERCENT CLOSURE/AB~DONMENT OF UNDERGROUND HAZARDOUS SUBST~CES STORAGE IS FOR ~R~OVAL. 0R ~ ~O0~ IN P~CE (PILL 0~ THIS APPLICATION REMOVAL cONTRACTOR IAOOREJS .-, · ~.%"G4.-d2 PHONE ~:,~ ~',:_., ,~.:.~ ~ ~(~, , .~.u~.~, .. ~ ~_~ ;..c/.u.~(~,,~,, . ,~,.~ ~,. ~ . - - PRO~. PROJE~ ~ING DA~ {~LIFORNIA LICENSE · ~RK~'S COMP~SATION · ' {INSL~ .... ~ ................. P~U~zMA~ s~Te ~Ss~s~ corem ~u~s P.O.~ ~.,~.-~., ~c .... ~> ~. ~~ ~ (~) - CHF,.MICAL COMPOSITION OP MATERIALS STORED TANK · VOLUME CHEMICAL STORED (NON-CO~W~RCIAL NAME) DATES STORED CHEMICAL PREVIOUSLY' STORED / ~ ~.--. / i /~ . /f(. ;' ('/ ~ , . ''. - ' -- -, , ~-, ~ ....... ~ ,-; ,.:~ ,_-, / ;,-'~-~'~Q",'~-'~.':/'~'~_ ~ .."! ...w '.~ t~ATER TO FACILITY PROVIDED BY .L. ',.. ' ~" (--- /~D .').~ :', .d i -, ~ ' NEAREST WATER WELL - GIVE DISTANCE AND DESCRIBE TYPE IP WITHIN 500 PEET /, _ ~ ~ ',,. -, ~;' "~-~ .- .".'_ ~ ,' ~ ." 'L .... ~,SIS FOR SOiL TYPE AND GROUNDWATER DEPTH DETERMINATION DE~'R TO ONDUMOWA~ L -~--." ,' ~-- ~"~ -'r (. C I $0IL TYPE AT PACILITY ~ 'L ~- }.. ~._./~.-"~ L..-~ rOTAL NUMBER OF SAMPLES TO BE AMA~YZED SAMPLES WILL S£ ANALYZED FOR: ,-.-u/,~--,' ._, ~:~,,, ,,, , · -., . }ESCHIBE HOW RESIDUE IN TANKIS) AND PIPING IS TO BE REMOVEJ} AND DISPOSED OF (INCLUDE TRANSPOR~ATIOM,, AND DIS~SAL ~, ~-.~,t~ -...~ ,"~ ~'"~',~,,-, , .-, ~, ,,, ~-~ , '~ " -' '~ ' ~ ,~~ ]~CRIBE ~OTll ~E DISPOSAL ~OD ~ 'DIS~S~:~TION FOR: - ~-, '~ ,' ; · L , - ~K~S) CL,~-~ ~/L~C.~' " ..... ; ~ ""'~ ' "~ .... P[PINO PLEASE PROVIDE INNDRMATTON REQUESTED ON REVERSE SIDE DP TRIS SHEET EEPORE SUBMITTING APPLICATION FOR REVIEN ' * SIGNATUR~ .... , __ TITLE ~ DATE (Form ~HMHP-140) · 1700 Flower Str6et, Bakersffield, L.. 93305 HAZARDOUS. SUBSTANCES STORAGE FACILITY Type of Application (check): [-]New Facility. DModification of, Facility [-]Existing Facility· []Transfer of O~nership Emergency 24-Hour Contact (name, area code, phone): Days ~?J' Faciiity , No. of Tanks / Type of Business (check): ~] Ga so l'i ne Station ~)~herJdeSCribe) Is Tank(s) Located on an Agricultur. al Farm? []-]Yes ~ / Is Tank(s) Used Prima~rily .for' Agr,icultural Purposes? ~]Y~s [] No · Facility Address ~_~_'~ .-~ Nearest Cross St. T R SEC Owner (Rural Locations (~ly)' Contact Perso~ Zip F2.~ FK),,~. Telephone Con.ct ~r~ Zip Tele~ne Address - ~"~7~, ~;~k~ _~/~ Operator ~/~Z~ ~. Address a~ ';%. 'Water-to Facility Provided by Soil (~aracteristics' at Facility ~,~ Basis for .Soil Type and Groundwater DeDth'Determi6ations ~.~..,/ ~~ ~,~ Contractor ~J///S/~m~-~ ~/ Address Proposed Starting Date Worker' s CCmpensation' Certification Ce CA Contractor' s License No. Zip Telephone Propose~ CcmpI~tion ~te Insurer Proposed /~./~. . E. ; Tank(s) Store (check all that apply): Tank ~ Waste' Product Motor Vehicle Fuel [] [] [] [] [] [] [] 'ID [] [] [] [] Unleaded Regular Premi,~ Diesel Waste Chemical Ccmposition Of Materials Stored (not-necessary for motor vehicle fuel's) Tank ! Chemical Stored (non-coe~ercial name) CAS ~ (if kno~) Chemical Previously Stored (if different) . Transfer of Ownership ~ate of Transfer Previous Facility Name I, Previous Owner accept fully all obligations of Permit No. issued to I understand that the Permitting Authority may review and modify or terminate the transfer of the facility upon receiving this cc~upleted form. Permit to Operate, this ~dergro~d storage This form has been ccmpleted under penalty of perjury and to the best of my knowledge is true and correct. ............. Signature '~ H. 1. Tank is: [~Vaulted ~lNon-Vaulted ~]Double-Wall [']Single-Wall 2. ~ Material  'C~bon- Steel [~ Stainless Steel . ['~ t~lyvin¥1 Chloride ['~ Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [] Concrete [] Altmin~ [] Bronze ~Unknown Other (describe) Contair~ent Primary , , I~te installed Thickness (Inches) Capa~ctty (Gallons) Manufacturer Tank Sec6~ary Containment -~'Double-Nall." [-J Synthetic Lfner [~Lined Vault ~None []Unkno~ FlOther (describe): Manufacture~: I'l~terial ':~ Thickness (IncheSi .... Capacity (Gals.) Tank I, aterior Linin9 []la~ber rl~lk~ rlEl~xy l'll~enolic []Glass []C~ay []l~lir~d ~kno~ []Other (describe) ~ .,' .' ".,' ~. ¥~ ~-~i~l (vaulted ~n~ only) n~rou~mter Monitorir~ well is) []Vedose Zor~ ~i~oring Well(s) l'l~Tube Witl~out Liner [] Valor Petac~or' []Liquid ~el 'b. Pipit: ~l~~ric~i~ ~ak ~or(s) ~or PrOviz~ Pipit' ~nitori~ ~ ~ ~c~y ~1~ ~rete ~ Unknc,,,~ []Other *Describe Make & 8. Tank Tightness ~as ThZs Tan~ ~een Tightness Tested? Date of Last Tightness Teac Test N~e ~el~ired~ []Yes Results of Test: Testing Cm~pany ,, Da~(s) of l~pair(s) Describe Repairs i0. Overfill Protecti~ ' ' ~Operator Pil~a, controls, & Visually Monitors Level [~Tape Float Gau~e []Float Vent Valves [~ Auto Shut- Off Controls _ ~]Capacitance Sensor []Sealed Fill Box []None FTt~kno~ ~JOther: List Make & Model For At.va Devices 11.- Pipt~ a. ~derground Piping: ~iYps ' []No []Onkno~ Material Thickness (inches) Diameter Manufacturer [']Other (describe): ....... ......... : .. I-IPressure []Su~t'ion [~Gravit¥ Approximate Length of Pipe l~ b. Underground Piping Corrosion Protection : / []Galvanized []Fiberglass-Cled []Impressed Current []Sacrificial Anode ['lPolyethylene Wrap' [~]~.lectri~al Isolation ~]Vin¥1 Wrap U1Tar or Aspl~alt ..... ~]Unkno,.ri []None [~Other-(describe)-: ........ : - ''. ......... c.. Underground Piping, Secondary Containment: [~Double-Wall [~Synthetic Liner System ~None [~Unknown Oxford~ MADE; IN U.8.A. NO. 752