My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SITE HISTORY
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CHARTER
>
440
>
2900 - Site Mitigation Program
>
PR0536618
>
SITE HISTORY
Metadata
Thumbnails
Annotations
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
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
30
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
STATE OF CALIFORN% WATER RESOURCES CONT# ARD go <br /> FORMV: UNDERGROUND STORAGE TANK PROGRAMTANK PERMIT APPLICATION INFORMATION <br /> TANK COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. <br /> 1 NEW PERMIT ❑3 RENEWAL PERMIT <br /> 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED TANK <br /> MARK ONLY ❑ ❑4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED 1 j <br /> ONE ITEM ❑ 2 INTERIM PERMIT FARM TANK-YES❑!NO ❑ <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: „) <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SCIFY <br /> B MANUFACTURED BY'. CC <br /> A. OWNERS TANK 10# a' <br /> D. TANK CAPACITY IN GALLONS J V r7 <br /> C.YEAR INSTALLED /< Y i <br /> COMPLETE ITEM B IF (A.1),IS NOT MARKED COMPLETE ITS 2 <br /> II. TANK CONTENTS IF(A.1),IS MARKED, LEADED 3 DIESEL <br /> A. ❑ 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM El 1 PRODUCT ❑4 GASAHOL ❑ 5 JET FUEL El AVIATION GAS <br /> ❑3 CHEMICAL PRODUCT ❑4 OIL 7 METHANOL ❑99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> ❑5 HAZARDOUS ❑ BO 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 ❑ UNKNOWN <br /> DOUBLE WALLED ❑3 SINGLE WALLED WITH EKTERIOfl UNER <br /> 95 A.TYPE OF ❑q SECANDARt COMAINMENi ❑99 OTHER <br /> SYSTEM �'G SINGLE WALLED <br /> ❑ i RRON <br /> Li2 STAINLESSSTEEL 3 FIBERGLASS ❑d STEEL CIADWIFlBERGIASS REINFORCED PLASTIC <br /> B.TANK F-15 CONCRETE <br /> CONCRETE ❑6 POLYVINYLCHLORIDE 7 YAAIUM8100%METHANOL COMPATIBLE FRP <br /> MATERIAL 10 GALVANIZED STEEL UNKNOWN ❑99 OTHER <br /> ❑9 BRONZE ❑ <br /> ❑1 RUBBER UNER ❑2 ALKYDUNING ❑ 3 EPDXY LINING I PyENOLIC LINING <br /> C.INTERIOR 6 UNLINED I^�,y55 UNKNOWN <br /> LINING ❑ I GLASS LINING ❑ <br /> ❑ IS LINING MATERIAL COMPATIBLE WITH 10096 METHANOL? ❑YES ❑NO ❑99 OTHER <br /> D.CORROSION <br /> 1 POLYETHLENEWRAP 2TAR OR ASPHALT 3V WRAP ❑4FlBERGlASS REINFORCED PLASTIC <br /> ❑ ❑ 5 UNKNOWN ❑ 99 OTHER <br /> PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND. 0 IFUNDERGROUND,BOTH IF AAPPLIC�ABNONE A U 95 UNKNOWN A U 99 OTHER <br /> A. SYSTEM TYPE A U 1 SUCTION <br /> A 2 PRESSURE A U 3 GRAVITY <br /> B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A 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 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE IPVC) A U 4 FIBERGLASS PIPE A U 91 NONE <br /> 8100%METHANOL COMPATIBLE FRP <br /> C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELCLADW/FRP A U <br /> A U 9 GALVANIZED STEEL A U 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 8 1 VISUALCHECK IP/, 8 2 INVENTORY RECONCILIATION F 9 91VADOSE WELLS F NONE B 95EUNKNOWN LECTRONIC MONITOR PP SS 99 OTHER <br /> WATER MONITORING WELLS <br /> P S 6 PRECISIONTESTING P 8 7 PRESSURE TESTING <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 3 WASTANKFILLEO WITH <br /> 1.ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF INERT MATERIAL? DYES ❑ NO <br /> SUBSTANCE REMAINING IN 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 A SIGNATURE) <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTIONS AGENCY# FACILITY ID; TANKID= <br /> F=E <br /> m 1.� APPROVED BY NAME0 P 01 6L,A1 CODE <br /> CURRENT LOCAL AGENCY FACILITY IDX <br /> I L <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> CHECK# PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT# BY: <br /> FORM B(6-29-86) THIS FORM MUST BE ACCOMPANX-0 BY A FACILITY/SITE APPLICATION, FORM 'A',UNLESS A C tRRENT FORM'A' HAS BEEN FILED <br /> FILE COPY <br />
The URL can be used to link to this page
Your browser does not support the video tag.