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SITE HISTORY
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LAMMERS
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24100
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2900 - Site Mitigation Program
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PR0508110
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SITE HISTORY
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Entry Properties
Last modified
2/14/2020 3:57:12 AM
Creation date
2/13/2020 9:52:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE HISTORY
RECORD_ID
PR0508110
PE
2950
FACILITY_ID
FA0006134
FACILITY_NAME
POMBO RANCH
STREET_NUMBER
24100
Direction
S
STREET_NAME
LAMMERS
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
24002002
CURRENT_STATUS
01
SITE_LOCATION
24100 S LAMMERS RD
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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4 Ya= 771 <br /> STATE OF CALIFCRIV WATER RESOURCES 6ONTARD s• <br /> FORM `B': UNDErtGROUND STORAGE TANK PROuRAM <br /> wo <br /> TANK TANK PERMIT APPLICATIO INFORMATION <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWI G 1 ORMATION FOR EACH TANK. <br /> i0 <br /> MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CL K <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED <br /> w <br /> FACILITY/SITE NAME WHERE TANK 15 INSTALLED: 0 MM FARM TANK YE75 O <br /> NO ❑ (, <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-$O SPECIFY 3/ <br /> A. OWNERS TANK ID Ii B. MANUFACTURED BY: µ <br /> C.YEAR INSTALLED D. TANK CAPACITY IN GALLONS: V <br /> 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),ISN T MARKED,COMPLETE ITEM D. <br /> A. ❑ 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM B. C. ❑ 1 UNLEADED ❑2 LEADED ❑ 3 DIESEL <br /> ❑3 CHEMICAL PRODUCT ❑ 4 OIL ❑ 1 PRODUCT ❑ 4 GASAHOL ❑ 5 JET FUEL ❑ 6 AVIATION GAS <br /> ❑5 HAZARDOUS ❑ 80 EMPTY 5 UNKNOWN E:] 2 WASTE El METHANOL ❑ 99 OTHER(DESCRIBE 1N ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.It C.A.S.9: <br /> III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C.&D - <br /> A.TYPE OF ❑ 1 DOUBLE WALLED ❑ 3 SINGLE WALLED WITH EXTERIOR LINER 5 UNKNOWN <br /> SYSTEM ❑2 SINGLE WALLED ❑ 4 SECONDARY CONTAINMENT ❑ 99 OTHER <br /> ❑ 1 STEELIIRCN ❑ 2 STAINLESS STEEL ❑ 3 FIBESS ❑ 4 STEEL CLAD W/HBERGLASSREINFORCED PLASTIC <br /> B.TANK <br /> MATERIAL ❑ 5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑ 7 MINUM F-18 100%METHANOL COMPATIBLE FRP <br /> F-19 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN ❑99 OTHER <br /> C.INTERIOR F-11 RUBBER LINED E] 2 ALKYD LINING ❑3 EPDXY LINING ❑ 4 PHENOLIC LINING <br /> LINING ❑ 5 GLASS LINING ❑ 6 UNLINED 95 UNKNOWN <br /> ❑ IS LINING MATERIAL COMPATIBLE WITH 1W%METHANOL? ❑YES Q NO ❑ 99 OTHER <br /> D.CORROSION ❑ 1 POLYETHLENE WRAP ❑2 TAR OR ASPHALT R�95 <br /> L WRAP E]4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION ❑ 5 CATHODIC PROTECTION ❑91 NONE UNKNOWN ❑99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROU D,BOTH IF APPLICABLE <br /> A.SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE < U 95 UNKNOWN A U 99 OTHER <br /> B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LIN ED TRENCH A U 91 NONE. A U 5 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 ACONCRETE A U 7 STEEL CLAD W/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 9 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P - 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P (SJ95 UNKNOWN P S 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH <br /> SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? [71YES ❑ NO <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TD THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED&SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> FNUMBER <br /> JURISDICTION# AGENCY# FACILITY ID# TANK ID# <br /> O Gf0C� a � / <br /> mCJi11T,Y li APPROVED B NAME PHONE#WITH AREA CODE <br /> �(��J' PERMIT APPROVAL DATE PERMIT EXPIRATION DATEMIT AMOUNT SURCHARGE AMT. FEE CODE ECEIPT# BY: <br /> FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE APPLICATION, FORM 'A',UNLESS A CURRENT FORMA' HAS BEEN FILED <br /> DATA PROCESSING IPOPY <br />
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