SITE HISTORY - Laserfiche WebLink

Home Browse Search

STATE OFCALIFORKA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PE MIT APPLICATION- FORM B 0 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY © 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLY NOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ TEMPORARY TANK CLOSURE • TANK REMOYEO� J� I DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Tri Star Homes I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK I.0.4 UnknMm B. MANUFACTURED BY: C. DATE INSTALLED{MOIDAYNEAR) Unknown 0. TANK CAPACITY IN GALLONS: 800 Mllons II.TANKCONTENTS IF A•I1SMARKED.COMPLETE ITEM C. A. t MOTOR VEHICLE FUEL 0 4 OIL B. C. I&REGULAR 3 DIESEL 8 AVIATION GAS UNLEADED ❑ 2 PETROLEUM ❑ 90 EMPTY ❑ 1 PRODUCT ❑ 1b PREMIUM 4 GASOHOL ❑ 7 METHANOL 3 CHEMICAL PRODUCT 95 UNKNOWN 2 WASTE UNLEADED El5 JET FUEL ❑ ❑ ❑ ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.9: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C,AND ALL TH T APPLIES IN BOX 0 AND E A TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOP LINER ❑ 95 UNKNOWN SYSTEM ® 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT 0 fAULTEDTANK) ❑ 99 OTHER S. TANK ® I BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ e POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100x, METHANOL COMPATIBLE WrFRP (PrimaryTenk) ❑ 9 BRONZE ❑ 10 GALVANIZED,STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ t RUBBER LINED ❑ 2 ALKYO LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING 6 UNLINED ❑ UNKNOWN LINING ❑ 99 OTHER IS UNING MATERIAL COMPATIBLE WITH 100%METHANOL? YES NOT D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION 91 NONE ❑9 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) none OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) none IV. PIPING INFORMATION CIRCLE A IF ABOVE G ROUND OR U IF UNDE AGROUND,8 OTHIFAPPLICABLE A. SYSTEM TYPE A 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A l SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 90 OTHER C. MATERIAL AND A ® I BARE STEEL A U 2 STAINLESS STEEL A V 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEEL WICOATING A U 8 100% METHANOL COMPATIBLE WIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTKI A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ I AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3 MONrtOR1NG ❑ 99 OTHER none V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORI F] 4 AUTOMATIC TANK GAUGING E:] 5 GROUND WATER MONITORING ❑ 6 TANK TESTING ❑ 7 IN7E14571TIAL MONITORING 91 NONE ❑ 95 UNKNOWN ❑ 09 OTHER VL TANK CLOSURE INFORMATION 1.ESTIMAD DATE LAST USED IMOIDAY/YR) 2.ESTIMATED OUANTITY OF 3.WAS TANK FILLED WITH Dnknown SUBSTANCEREMA4NING Unknown GALLONS INERT MATERIAL? YES ❑ No ® THIS FORM HAS BEEN COMPLET D UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAMERZ..C. Ore for Tri Sta Homes DAT -1 (PRINTED A SIGNATU", �2 i/97 jr LOCAL AGENCY USE ONL THE STATE E.D.NUMBER IS C POSED OF THE FOUR NUMBERS BELOW COUNTY N JURISDICTION 9 FACILITY N TANK O STATE LD.# m = El I I I I I I I I PERMIT NUMBER PERMIT APPROVED BYiDATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE.UNDERGROUND STORAGE TANK REGULATIONS DORM 8 (1291)