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HomeMy WebLinkAboutPERMIT APPLICATION 3/26/2010 UNIFIED PROGRAM CONSOLIDATED FORM IIIIIIIIIIIIIIIIIIII 35 IE UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION(one form per UST) TYPE OF ACTION (Check one item only. For an UST permanent closure or removal,complete only this section and Sections I,II,III,IV,and IX below) 430 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT ® 5.CHANGE OF INFORMATION ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4300 1 DATE EXISTING UST DISCOVERED: 430b I.~FACILPTY INFORMATION FACILITY ID#(Agency Use Only) I BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 Pacific Bell Telephone company dba AT&T Califomia SA098 BUSINESS SITE ADDRESS 103 CITY 104 3221 South H Street Bakersfield •II.TANK DESCRIPTION TANK ID# 432 TANK MANUFACTURER 433 TANK CONFIGURATION: THIS TANK IS 434 SA0980001 MODERN WLD ® 1.A STAND-ALONE TANK ❑2.ONE IN A COMPARTMENTED UNIT. Complete one Me for each compartment in the unit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437 5/1/04 6016 1 IIIz"TANK USE•AND,CONTENTS= TANK USE ❑ la.MOTOR VEHICLE FUELING ❑ lb.MARINA FUELING ❑ lc.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(Includes Used Oil) ® 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER (Specify): 439a CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ❑ ]b.PREMIUM UNLEADED 440 ® 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS ❑ 8.PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM (Specify): 440a NON-PETROLEUM:❑ 7.USED OIL ❑ 10.ETHANOL ❑ 11.OTHER NON-PETROLEUM(Specify): 440b i IV T�A1VK CONS,T_RUC�iTION=, TYPE OF TANK ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN 443 PRIMARY CONTAINMENT ® 1.STEEL ❑ 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 444 ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER (specify): 444a SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED 405 ❑ 90.NONE ❑ 95.UNKNOWN ❑99.OTHER(Specify): 445a OVERFILL PREVENTION 0 1.AUDIBLE&VISUAL ALARMS 2.BALL FLOAT 0 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4.TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT i , �V ,'PRO1DUCT/3WASTEsPIPING C�ONSITRUC�rTIUN; i t ,, PIPING CONSTRUCTION ❑1.SINGLE-WALLED ®2.DOUBLE-WALLED [199.OTHER a 460 SYSTEM TYPE ❑ 1.PRESSURE ❑ 2.GRAVITY ® 3.CONVENTIONAL SUCTION ❑ 4.SAFE SUCTION[23 CCR§2636(a 3)] 458 PRIMARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464 ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464a SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ® 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464c PIPINGt TURBINE CONTAINMENT SUMP TYPE ® 1.SINGLE WALL ❑ 2.DOUBLE WALL ❑ 90.NONE 464d "VY`rVE_NAT'> �ORItE`COVERI'{�' �uAND RI$E_R_�/`FIL_L PIPE PIPIN�'G C'ONST_RUCTION VENT PRIMARY CONTAINMENT L STEEL _ 4.FIBERGLASS y X10.RIGID PLASTIC El 90.NONE 99.OTHER(Specify) 464e 464cl VENT SECONDARY CONTAINMENT 1.STEEL 19 4.FIBERGLASS 10.RIGID PLASTIC 90.NONE 0 99.OTHER(Specify) 464f 46411 VR PRIMARY CONTAINMENT tj L STEEL 4.FIBERGLASS Ll 10.RIGID PLASTIC 19 90.NONE E3 99.OTHER(Specify) 4648 464 1 VR SECONDARY CONTAINMENT ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ® 90.NONE 99.OTHER(Specify) 464h 464h1 VENT PIPING TRANSITION SUMP TYPE 13 1.SINGLE WALL 2.DOUBLE WALL 0 90.NONE 464L RISER PRIMARY CONTAINMENT 0 L STEEL tj 4.FIBERGLASS 10.RIGID PLASTIC Ej 90.NONE 99.OTHER(Specify) 4641 464'I RISER SECONDARY CONTAINMENT Ej L STEEL 0 4.FIBERGLASS Ej 10.RIGID PLASTIC 90.NONE 99.OTHER(Specify) 464k 464kl FILL COMPONENTS INSTALLED 1.SPILL BUCKET t9 3.STRIKER PLATE/BOTTOM PROTECTOR 0 4.CONTAINMENT SUMP 45la-c '"' t ' }' VIIilNDERDISPENSE_RC,ONT�A_INMENT(UDC)..'`� ; CONSTRUCTION TYPE ❑ 1.SINGLE WALL ❑ 2.DOUBLE WALL ® 3.NO DISPENSERS ❑ 90.NONEy 469a CONSTRUCTION MATERIAL ❑ 1.STEEL ❑ 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHERS i 469Irc v � t •� 4 ; VIII 'CORROSION �s�.'_ 7 ...��.,.- ..s...> STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4•IMPRESSED CURRENT ® 6.ISOLATION 448. A_PPLICANTaSIGNA]TIU�_' : ' `.:; U711 � CERTIFICATION: I certify that this UST sy'19As compatible with the azardous substance stored and that the information provided herein is true,accurate, and in full compliance legal r ui e APPLICANT SIGNATURE DATE 470' 3/26/2010 APPLIC 471- APPLICANT TITLE 472. Steven J Hall Manager EH&S UPCF UST-B-1/1 IIIIIIII VIII III IIII 36 Rev.(1212007) IE