SITE HISTORY - Laserfiche WebLink

Home Browse Search

¢ STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD a UNDERGROUND STORAGE TANK PER AIT APPLICATION - FORM Bmo a COMPLETE A SEPARATE FORM FORE CH TANK SYSTEM. MARK ONLY Fln, 1 NEW PERMIT 3 RENEWAL PERMIT F7 5 CHANGE OF INFORMATION E:] 7 PERMANENTLY CLOSED ON SITE ONE ITEM El 2 INTERIM PERMIT F-1 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE E:] 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED; Tri StAr jqoMaso j I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A- OWNER'S TANK I.D.0 Unknom I B. MANUFACTURED BY: Unkno 1 C. DATE INSTALLED(MOlDAYlYEAR) UnknoM L I TANK CAPACITY IN GALLONS: loo agllon.q II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. A_ 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C. ❑ la REGULAR UNLEADED 3 DIESEL ❑ 6 AVIATION GAS 2 PETROLEUM BO EMPTY 1 PRODUCT ❑ lb PREMIUM UNLEADED 4 GASAHOL ❑ 7 METHANOL ❑ 1c MIDGRADE UNLEADED ❑ 5 JET FUEL F7 8 M85 3 CHEMICAL PRODUCT 95 UNKNOWN 2 WASTE © 2 LEADED L-1 99 OTHER(DESCRIBE IN ITEM D.BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.4: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALL TH T APPLIES IN BOX D AND E A. TYPE OF ❑ 1 DOUBLE WALL E-] 3 SINGLE-WALL WITH EXTERIOR LINER 5 INTERNAL BLADDER SYSTEM 95 UNKNOWN SYSTEM 2 SINGLE WALL 4 SINGLE WALL IN A VAULT 99 OTHER 8. TANK L'J 1 BARE STEEL 2 STAINLESS STEEL ❑ 3 FTBERGLASS ❑ 4 STEEL CLAD W!FIBERGLASS REINFORCED PLASTIC MATERIAL F-� 5 CONCRETE 6 POLYVINYL CHLORIDE 7 ALUMINUM 8 100% METHANOL COMPATIBLE WfFRP (Primary Tanks ❑ 9 BRONZE.- ❑ 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER C.INTERIOR ❑ T RUBBER LINED = 2 ALKYD LINING 3 EPDXY LINING 4 PHENOLIC LINING LINING OR 5 GLASS LINING � 6 UNLINED 95 UNKNOWN 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 1009/6 METHANOL? YES NO— D.EXTERIOR 1 POLYETHYLENE WRAP ❑. 2 COATING ❑ 3 INYL WRAP 4 FIBERGLASS REINFORCED PLASTIC I CORROSION PROTECTION ❑ 5 CATHODIC PROTECTION I g1 NONE ❑ 95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL,CtC. SPILL CONTAINMENT INSTALLED(Yf-AR) OVER ILL PREVENTION EQUIPMENT INSTALLED(YEAR) DROP TUBE YES NO---Ac STRIKER PLATE YES NO---X_ DISPENSER CONTAINMENT YES NO__Y_--_ i IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND BOTH IF APPLICABLE I A. SYSTEM TYPE A tD 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U .99 OTHER 3 B. CONSTRUCTION A l i SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE a CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W%COATING A U 8 100%METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER 1 MECHANICAL LINE LEAK 2 UNE TIGHTNESS3 CONTINUOUS INTERSTRR L Ej 4 ELECTRONIC UNE 5 AUTOMATIC PUMP D. LEAK DETECTION F-1DETECTORTESTING ❑ MONITORING LEAK DETECTOR ❑ SHUTDOWN ❑ 59 OTHER V.TANK LEAK DETECTION T VISUAL CHECK ❑ 2 RECONCILIATIONMANUAL MONITORING 3 MONIITORING 4 GAUGING AUTOMATIC TANK 5 NEON TORINGTER a & TESTINGTANK 7 CONTINUOUS INTERSTITIAL 8 SIR ❑ 9 WEEKLY MANUAL10 MONTHLY TANK [X] 95 UNKNOWN E:] 99 OTHER MONITORING TANKGAUGING TESTING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATEDtQ�l'i.'11114wS;�j�15ED(MO!{]AYNR) 2.ESTIMATED QUANTITY OF om 3.WAS TANK FILLED WITH YES NO SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 El THIS FORM WAS BEEN COMPLETED UNDEFLPENALTY OF PERJURY,AND rO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNER'S NAME BIZ ent for Wrl 6var Homes, ULd DATE ;e{/Y-( {PRINTED 8 SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS C MPOSED OF THE FO JR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.4 mEl I Im�nm PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APP TION-FORM A,UNLESS A CURRENT FORM HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLO JI. FILE THIS FORM WITH THE LOCAL AGEHC IMPLEMENTING TtOftqDERGROUND STORAGE TANK REGULATIONS FORM B (6-95) a'