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BILLING_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231052
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BILLING_PRE 2019
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Entry Properties
Last modified
9/12/2024 3:43:17 PM
Creation date
11/5/2018 11:37:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0231052
PE
2381
FACILITY_ID
FA0009377
FACILITY_NAME
CAL TRANS MAINT SHOP 10
STREET_NUMBER
1603
Direction
S
STREET_NAME
B
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
16918002
CURRENT_STATUS
02
SITE_LOCATION
1603 S B ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\B\B\1603\PR0231052\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
12/28/2011 8:00:00 AM
QuestysRecordID
107580
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD <br /> FORM `B': UNDERGROUND STORAGE TANK PROGRAM <br /> TANK TANK PERMIT APPLICATION INFORMATION , m <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. __ z <br /> 10 <br /> MARK ONLY ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATIONRMANENTLY CLOS <br /> ONE ITEM 2INTERIM PERMIT ❑ 4 AMENDEDPERMIT 6 TEMPORARY TANK CLOSURE S TANK REMOVED <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: O 5 FARM TANK-YES N ,� <br /> 0 <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY 00 <br /> A, OWNERS TANK ID# o B. MANUFACTURED BY: U N <br /> C. YEAR INSTALLED 7 - D. TANK CAPACITY IN GALLONS. '43099 <br /> II. TANK)CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARK.E9116OMPLETE ITEM D. <br /> A. M I MOTOR VEHICLE FUEL ❑2 PETROLEUM B. C. 1 UNLEADED ❑2 LEADED ❑ 3 DIESEL <br /> ❑3 CHEMICAL PRODUCT ❑ 4 OIL 1 PRODUCT E]4 GASAHOL ❑ 5 JET FUEL ❑6 AVIATION GAS <br /> ❑5 HAZARDOUS ❑ 80 EMPTY ❑ 95 UNKNOWN ❑2 WASTE ❑7 METHANOL ❑99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.# CA.&#: <br /> III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D <br /> A. TYPE OF al DOUBLEWALLED ❑ 3 SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN <br /> SYSTEM RL!yJT 2 GLE WALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER <br /> 119 I STEEUIRON ❑2 STAINLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B. TANK ❑ 5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑7 ALUMINUM ❑ <br /> MATERIAL B 1W%METHANOL COMPATIBLE FRP <br /> ❑9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑99 OTHER <br /> C. INTERIOR ❑ 1 RUBBER LINED ❑2N.KYD LINING ❑3EPDXY UNINGNOLIC UNING <br /> LINING F-15 GLASS UNING F-16 UNUNED 95 UNKNOWN <br /> ❑ IS LINING MATERIAL COMPATIBLE WITH 100%MEIHANOL? ❑YES ❑NO ❑ 99 OTHER <br /> D. CORROSION ❑1 POLYETHLENE WRAP ❑2 TAR OR ASPHALT W VNYL ❑4 FIBERGLASS REINFORCED PLASTIC <br /> �- <br /> PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE 95 UNKNOWN ❑99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A. SYSTEM TYPE A A I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A 95 UNKNOWN A U 99 OTHER <br /> B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASSPIPE A U 91 NONE <br /> C. MATERIAL A U 5 ALUMINUM A8 CONCRETE A U 7 STEEL CLAD WEEP A U 8100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> 8 1 VISUAL CHECK P 5 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P 5 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> I�I P 5 6 PRECISION TESTING S 7 PRESSURE TESTING P 8 91 NONE P S 95 UNKNOWN P S 99 OTHER <br /> 'V VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH <br /> SUBSTANCE REMAINING IN INERT MATERIAL? ❑YES ❑ NO <br /> _ GALLONS <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED 8 SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# <br /> � ^ 10o air 0o ° <br /> CURRENT LOCAL AGENCY FACILITY ID# APPROVED BY NAME PHONE#WITH AREA CODE <br /> PERMIT NUMBER PERMIT APR VALDATE„ PERMIT EXPIRATION DATE <br /> 6 <br /> CHECK# PERMIT AMOUNT I SURCHARGE AMT. FEE CODE RECEIPT# Lyf� <br /> cC,M B I6-z9-661 THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE APPLICATION, FORM `A',UNLESS A CURRENT FORMA' HAS BEEN FILED//YY..--�� <br /> DATA PROCESSING COPY <br />
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