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2900 - Site Mitigation Program
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PR0536618
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SITE HISTORY
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Entry Properties
Last modified
3/1/2019 3:50:52 PM
Creation date
3/1/2019 3:04:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE HISTORY
RECORD_ID
PR0536618
PE
2960
FACILITY_ID
FA0021026
FACILITY_NAME
STOCKTON CHARTER WAY COMMON PLUME
STREET_NUMBER
440
Direction
W
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16503003
CURRENT_STATUS
01
SITE_LOCATION
440 W CHARTER WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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STATE OF CALIFORN% WATER RESOURCES CONTR ARD , <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. I <br /> MARK ONLY ❑ 1 NEW PERMIT <br /> ❑3 RENEWALPERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLYCNK <br /> ❑ 6 TEMPORARY TANK CLOSURE TANK REMOVED N <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑4 AMENDED PERMIT JE9 <br /> ,r>�N FARM TANK-YES❑ NO <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: y'- <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY N <br /> B. MANUFACTURED BY: <br /> A. OWNERS TANK IDp <br /> I� 6 O D. TANK CAPACIN IN GALLONS: � (7 P <br /> C.YEAR INSTALLED <br /> 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMFP�LDE DE ITEM 2 LEADED ❑ 3 DIESEL <br /> D. <br /> A. v❑ 1 MOTOR <br /> EMICALVEHICLE FUEL ❑ 2 PETROLEUM <br /> B. <br /> ❑4 GASAHOL ❑5 JET FUEL ❑ 6 AVIATION GAS <br /> ❑3 HAZARDOUS <br /> ALPRODUCT ❑ 4 OIL ❑ 1 PRODUCT 7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> ❑5 HAZARDOUS ❑ 60 EMPTY ❑95 UNKNOWN ❑2 WASTE ❑ ❑ <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.#: <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.# <br /> III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,d D <br /> A. TYPE OF7F',-�'2 <br /> ❑ I QOUBLEWALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN <br /> SYSTEM INGLEWAUEO ❑4 SECONDARY CONTAINMENT ❑99 OTHER <br /> 1 STEELIIRON ❑2 STAINLESS STEEL ❑ 3FIBERGLASS ❑ 4STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B. TANK ❑ 5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑ 7 ALUMINUM ❑ B 100%METHANOL COMPATIBLE FRP <br /> MATERIAL ❑y BRONZE ❑10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER <br /> ❑ 1 RU38ERLINED ❑2 ALKYD LINING ❑3 EPDXY LINING ❑4P)OOUWN <br /> LINING LINING <br /> C. INTERIOR ❑ ❑ <br /> LINING 5 GLASS UNING 6 UNLINED <br /> � ISLINING MATERIAL COMPATIBLE WITH 10096 METHANOL? ❑YES ❑ NO 99 OTHER <br /> D. CORROSION ❑ 1 POLYETHLENE WRAP ❑2 TAR OR ASPHALT ❑3 INYLWRAP ❑4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION F-15 CATHODIC PROTECTION ❑91 NONE 95 UNKNOWN ❑99 OTHER <br /> IV. PIPING INFORMATION CIRCLE AIF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLENONE A 95 UNKNOWN A_U 99 OTHER <br /> A. SYSTEM TYPE A U 1 SUCTION A U PRESSURE <br /> B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINEDTRENCH A U 91 NONE 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE <br /> C. MATERIAL A U 5 ALUMINUM A6 CONCRETE A U 7 STEELCLADW/FRP A U 8 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A 5 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 /> p S 1 VISUAL CHECK P S 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS PL-8 14 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> P S I PRECISION TESTING P 8 7 PRESSURE TESTING P S 91 NONE /P/S 95 UNKNOWN P S 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 3.WAS TANK FILLED WITH <br /> 2. ESTIMATED QUANTITY OF INERT MATERIAL? 0 YES E] P <br /> 1. ESTIMATED DATE LAST USED(MO/VRI SUBSTANCE REMAINING IN <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&SIGNATURE) <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION <br /> � AGE <br /> FACILITY ID# TANK ID# <br /> m <br /> FTIZ= cJ [� <br /> APPROVED BY NAME PHONE#WITH AREA CODE <br /> CURRENT LOCAL AGENCY FACILITY ID# <br /> PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> PERMIT NUMBER <br /> CHECK N PERMIT AMOUNT SURCHARGE AMT. <br /> FEE CODE ECEIPT# BY: <br /> FORM B(s-29-eBl THIS FORM MUST BE ACCOMPANIED BYAFACILITY/SITE APPLICATION, FORM 'A',UNLESS AcURRENT FORMA' HASBEENFILED <br />
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