BILLING 1985 - 1993 - Laserfiche WebLink

Home Browse Search

LYOuw .i CO • STATEOFCAUPORNA D u t f STATE WATER RESOURCES CONTROL BOARD /\�(��\/�\/� '' Irby/ UNDERGROUND STORAGE TANK PERMIT APPLICATION tl , , n+ COMPLETE A SEP EM =ONLI7 NEW PERMIT ❑,/YRENEWAL PERMIT cFr5 CHANGE OF IN�ATION 4y PERMANENTLY CL SITE INTERIM PERMIT I/i. d AMENDED PERMIT ❑ 8 TEMPORARY `AHK C� SURE B TANK REMOVED /I` DBA OR FACILITY NAME WHERE TANK IS INSTALLED:j' NW $� G I p-v I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. CWNER'S TANK I.D.a 8. MANUFACTURED BY: J ��/� C. DATE INSTALLED(MO/CAY/YEAR) V D. TANK CAPACITY IN GALLONS: CJ II.TANKCONTENTS IFA-11S MARKED,COMPLETE ITEM C. A I MOTOR VEHICLE FUEL ❑ 4 OIL 8. 0. Ia REGULUNLEAR B 3 DIESEL ❑ 6 AVIATCNGAS 4 GASAHOL 2 PETROLEUM ❑ 80 EMPTY JC 1 PRODUCT ❑ 1D PREMIUM ❑ 7 METHANOL UNLEADED 5 JET FUEL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM 0. BELOW) 0. IF;A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.a: III. TANK CONSTRUCTION MARKONE ITEMONLY IN BOXES AB.ANOC,AND ALL THAT APPLIES INBOXD A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM 2 SINGLE WALL ❑ 6 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ s STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B. TANK ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM C::] 8 100% METHANOL COMPATIBLE W/FRP MATERIAL F7 5 CONCRETE (PnmaryTank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ A PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING ❑ 6 UNLINED95 UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 1001:METHANOL? YES_ NO— D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ A FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IFUNDERGROUNO.BOTHIFAPPLICABLE A. SYSTEMTYPE A U I SUCTKJN A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER KB. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U a FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEELWICOATING A U 8 100% METHANOL COMPATISLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D.,LEAK DETECTION ❑ 1 AUTOMATKaINE LEAK DETECTOR [-] 2 LINE TIGHTNESS TESTING ❑ 3'IDNRORMn 'Wa ❑ W OTHER TANK LEAK DETECTION ,\ ❑ I VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING❑ A AUTOMATIC TANK GAUGING ❑ 5 GROUNDWATER MONITORING \{\\V ❑ 6 TANK TESTING ❑ 7 INTERSTRIALMONITORWG ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAYNR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL? VES ❑ NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME DATE IMYNTEO a# ATUM D LOCAL AGENCY USE ONLY THE STATE I.D.NUMBERS COMPOSED OF THE FOUR NUMBERS BELOW � v`J COUNTY# JURISDICTION# FACILITY# TANK# Y STATE I.D.# O D D PERMITNUMBER *� L PERMIT APPROVED 8Y/DATE PERMI EEXPIRATION DATE of I FORM B (9490) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORME-M