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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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PR0501700
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BILLING_PRE 2019
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Entry Properties
Last modified
9/27/2024 2:17:31 PM
Creation date
11/5/2018 12:10:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0501700
PE
2381
FACILITY_ID
FA0005192
FACILITY_NAME
GALAXY RENTAL CENTER
STREET_NUMBER
1155
Direction
E
STREET_NAME
BIANCHI
STREET_TYPE
RD
City
STOCKTON
Zip
95207
APN
10416022
CURRENT_STATUS
02
SITE_LOCATION
1155 E BIANCHI RD
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\B\BIANCHI\1155\PR0501700\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
12/30/2011 8:00:00 AM
QuestysRecordID
109424
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 <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. - <br /> MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWALPERMIT ❑5 CHANGE OF INFORMATION ❑7ERMANENTLY CLOSED <br /> ONE ITEM ❑2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE 8 TANK REMOVED O <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: FARM TANK-YES❑ NO � <br /> N <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY Ln <br /> CD <br /> A. OWNERS TANK ID# B. MANUFACTURED BY: (G <br /> C. YEAR INSTALLED D. TANK CAPACITY IN GALLONS: a <br /> II. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM B. C. ❑ i UNLEADED ❑2 LEADED 013 DIESEL <br /> ❑ 3 CHEMICAL PRODUCT ❑ 4 OIL IP PRODUCT ❑4 GASAHOL ❑5 JET FUEL [:]6 AVIATION GAS <br /> ❑5 HAZARDOUS ❑ 80 EMPTY ❑95 UNKNOWN ❑2 WASTE L]7 METHANOL ❑99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED S C.A.S.K C.A.S.M <br /> III. TANK CONSTRUCTION MARKON TEM ONLY IN BOXAB,C,BD <br /> A.TYPE OF ❑ 1 DOUBLE WALLED ❑3 NGLEWALLED WITH EXTERIOR UNER ❑95 UNKNOWN <br /> SYSTEM ❑2 SINGLE WALLED ❑4 CONDARY CONTAINMENT ❑99 OTHER <br /> ❑ 1 STEEUIRON ❑2%L7CTFL <br /> EEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B.TANK ❑ 5 CONCRETE ❑8 OROE ❑ 7 ALUMINUM ❑6 01h ME HANOLOCMPATIBLEFRP <br /> MATERIAL <br /> ❑9 BRONZE ❑ 10STEEL ❑ 95 UNKNOWN ❑99 OTHER <br /> C. INTERIOR ❑ 1 RJ88ERUNED ❑2 ALKYD UNI ❑3 EPDXY LINING ❑4 PHENOLICUNING <br /> LINING ❑5 GLASS UNING V' ❑fi UNLINED ❑95 UNKNOWN <br /> ❑ IS LINING MATERIAL COMPATIBLE WITH 1O METHANOL. ❑YES ❑NO ❑99 OTHER <br /> D. CORROSION ❑ 1 POLYETHIFNE WRAP ❑2 TAR OR ASPHALT ❑3 VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE 95 UNKNOWN ❑99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IFABOVEGROUND, U 1 NDERGROUND,BOTH IFAPPLICABLE <br /> A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A N 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASSPIPE A U 91 NONE <br /> C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A 7 STEELCLAD W/FRP A U 8100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U NOTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECO ARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> P S I VISUAL CHECK P 8 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P 8 7 PRESSURE TESTING P 8 91 NONE P 8 UNKNOWN P S 99 OTHER <br /> 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 GALLONSINERT MATERIAL? ❑YES NO <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 M JURISDICTION# AGENCY k FACILITY ID# TANK ID# <br /> � <br /> 11c <br /> CURRENT CURRENT LOCAL AGENCY FACILITY ID# APPROV O BY NAM tr PHONE N WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PIRMIT EXPIRATION DATE <br /> LdCHECK# PERMITAMOUNT SURCHARGEAMT. FEECODE RECEIPT# BY: <br /> FORM B(6-29-86) THIS FORM MUST BE ACCOMPANIED`TY A FALILITY/SITE APPLICATION, FORM 'A',UNLESS A=RENi FORMA' HAS BEEN FILED <br /> DATA PROCESSING COPY <br />
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