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2900 - Site Mitigation Program
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PR0536618
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SITE HISTORY
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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 CONT ARD <br /> FORM 'B': UNDERGROUND STORAGE TANK PROGRAM <br /> TANK TANK PERMIT APPLICATION INFORMATION <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING'NFORMATION FOR EACH TANK. <br /> MARK ONLY ❑ <br /> 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CWSEO-T NK <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE ❑B TANK REMOVED iN <br /> FARM TANK-YES NO <br /> ❑ <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: r 00 <br /> .P <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY O <br /> B. MANUFACTURED BY: Y�` <br /> A. OWNERS TANK ID# <br /> D. TANK CAPACITY IN GALLONS: <br /> C. YEAR INSTALLED <br /> 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. 1 MOTORVEHICLEIRODUCTL ❑ 2 PETROLEUM <br /> B C. ❑ 1 UNLEADED 2 LEADED ❑ 3 DIESEL <br /> ❑ 3 CHEMICAL PRODUCT ❑4 OIL <br /> 1 PRODUCT ❑4 GASOHOL ❑5 JET FUEL ❑6 AVIATION GAS <br /> 5 HAZARDOUS ❑BO EMPTY ❑95 UNKNOWN ❑2 WASTE ❑7 METHANOL ❑99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.W <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.# <br /> III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D <br /> F <br /> F ❑ 1IDOUBLE WALLED ❑3 SINGLEWALLED WITH EXTERIOR LINER ❑95 UNKNOWN <br /> a2 SINGLEWALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER <br /> ❑ 1 STEEUIRON ❑2 STAINLESS STEEL 3 FIBERGLASS ❑4 STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC <br /> ❑5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑7 ALUMINUM ❑6100%METHANOL COMPATIBLE FAP <br /> IAL ❑9 BRONZE ❑ 10 GALVANIZED STEEL ❑95 UNKNOWN ❑99 OTHER <br /> ❑ 1 RUBBER LINED ❑2 ALKYD LINING ❑ 3 EPDXY LINING ❑4 ENOLICUNING <br /> C. INTERIOR 5 GLASS LINING 6 UNLINED 95 UNKNOWN <br /> LINING ❑ <br /> ❑ IS LINING MATERIAL COMPATIBLE WITH 10096 METHANOL? [DYES ❑ NO ❑99 OTHER <br /> D.CORROSION ❑ 1 POLYETHLENEWRAP ❑ 2TAR OR ASPHALT ❑ 3VINYL WRAP ❑ 4 RBEAGLASS REINFORCED PLASTIC <br /> PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE E1,95 UNKNOWN ❑99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A SYSTEM TYPE A U 1 SUCTION A i U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> B.CONSTRUCTION A i U 2SINGLE 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 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASSPIPE A U 91 NONE <br /> C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U S 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A rU 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 lJ3 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUNDWATER MONITORING WELLS <br /> (3r-11 P S 6 PRECISION TESTING-P 8 7 PRESSURE TEBTING 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 /> 1. ESTIMATED DATE LAST USED(MO/YR) 2.ESTIMATED QUANTITY OF INERT MATERIAL? ❑YES ❑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 /> DATE <br /> APPLICANTS NAME(PRINTED 8 SIGNATURE) <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID#`` <br /> FCURRENTAL AGENCY FACILITY ID# APPROVED BY NAME PHONE#WITH AREA CODE <br /> ER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> PERMIT AMOUNT SURCHARGE AMT. FEE CODE <br /> RECEIPT BY: <br /> FORM B(6-29-BS) THIS FORM MUST BEACCOMPAN195 BY A FACILITY/SITE APPLICATION,COP ORM �A',UNLESS A RENT FORMA HAS BEEN FILED <br />
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