COMPLIANCE INFO_1995-2011 - Laserfiche WebLink

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l r 't�owc.i c SATE OF CALIFORNIA `. STATEWAMER RESOURCES CONTROL SOARD UNDERGROUND STORAGEETANK PERMIT APPLICA T ION - FORM B "d� in e.c.. ! COMPLEc c A SEPARAT'c FORM FOR EACH TANK SYS t C.'.'1. i i MARKONLY C 1 NEW PERMIT I 3 RENEWAL PE=RMIT 5 CHANGE OF INFORMAi.C.X 7 PERMANENTLY ONE ITEM 2 INTERIM PERMIT j 4 AMENDED PERMIT C o" TEMPORARY TANK CLOSURE a TANK REMOVE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 1� - 1. TANK DESCRIPTION COMPLETE ALL ITEMS- SPEC:FY IF UNKNOWN A. OWNER'S TANK 1.D.r %i :1 I S. MANUFACTURED BY: C. DATE INSTALLED(M=AYNEAR) / / I 0. TANK CAPACI T I IN GALLCNS; 11.TANK CONTENTS IFA-1 IS MARKED.CCMP`-T:'=iTEbAC. A. I t MOTOR VEHICLE FUEL ❑ a OIL 3. � i C. I l la AEGJW UNLEAOE3 I 3 DIESEL �1 5 .AVIATION GAS �-'-( L I 1b PRiNM UNIEAC'cD �I 4 GASAHCL 1-1 7 !AEir!ANCL 2 PE'raCLEl7M l 60 EMPTY t PROOUGT ❑ is UIDGRAOE JVLEACE71 �r�.s1 5 SET FUEL F-1 3 `A65 3 CHEMICAL PRODUCT I 45 UNKNOWN 2 WASTE c 2 LEADED I 99 OTHER(CESCSiBE iN f i Zi 0.3^L0(71) D. IF(A.1)IS NOT MARKF>. ENTER NAME OF SUBSTANCE 1 CRIED C.A.S.3 111. TANK CONSTRUCTION MARK ONE ITc'A CNLY IN BOXES A.3.AND C.AND ALL THAT APPLIES IN BOX 0 AND E ❑ COUSLE WALL 3 SINGLE 'NALL vom EXi2.RICR LINER 5 LNTcRNAL 3LAOCER SYS c.1 'JNKt:CTIN A. TYPE OF SYSTEM 2 SiNGL WALL 4 SINGLE WALL IN A VAULT ! 99 OTHER I B. TANK 1 sage STEEL2 STAINLESS STcEL 3 FIBERGLASS jj - S-..= C: O W/FIBERGLASS RENFCR.CcD PCAST c MATERIAL 5 CCNCSElc a POLYVINYL CHLORIDE C 7 ALUMINUM 3 1C01e METr9ANCL CCMPAT;BLIEW/FRP (Primacy Tank) Q 9 BRONZE ❑ 10 GALVANI'-_. STEEL C 35 UNKNOWN C 99 OTHER C.INTERIOR C 1 RUBBER UNED Q 2 ALKYO LINING i 3 EPDXY LINING Q 4 PHEINCL'C LINING LINING OR f-7 5 GLASS LINING U 6 UNLINED � 95 UNKNOWN 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 1007E ME riANCt? YES— NO_ D.ECTC.RIOR 1 POLYETHYLENE WRAP Q 2 COATING 3 VINYL WRAP C 4 FIBERGLASS REINFORCED PLAS71C CORROSION PROTECTION ❑ 5 CATHODIC PROTEC ION Q 91 NONE 195 UNKNOWN 99 OTHER E SPILL AND OVERFILL,ete SPILL CONTAINMENT INSTALLED(YEAR} OVERFILL PREVENTION ECUIPME ciNSTALLED(YEAR)� OROP TUBE YES NO aTnIKER PLATE YES NO DISPENSER CONTAINME.IT YES VO IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND CR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE i SUC .CN A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTr.ER S. CONSTRUCTION U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 45 UNKNOWN A U 94 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINL SSS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCREie A U 7 STE- W/COATING A U 3 100:METHANOL CCMPAiiBLEW/F;lP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHCOIC PROTECTION A U 5 UNKNOWN A U 99 OTHER ("'^,1 .4E WITA t3IE L:UC r j 2 TEM 1GHilESS I i 3 CW MXXJS W OST1UL �4 H.EC-MONC UNE 5 4UTCwUiC MW 9 OTHER D. LEAK DETECTION I_I oErECrA El 1Emv6 uaHraRM LIAR OEr'COA 4MOCWN V.TANK LEAK DETECTION 1 VISUAL CHECK Q 2 RC�-CONNCCIWTIONORY (�j 3 MONITORINGOZE E 4 GAUGING C TANK �5 GROUND WATER �6 TESTING 7 CONTINUONUGS INTERSTITIAL Q 6 SIR `-+ 9 WISEKLTANKGAUG MANUAL 7-110 MO TIHLY TANK 45 UNKNOWN 99 OTHER VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-?LACcEI 1.ESTIMATED DATE LA.T USED(MO/DAYNM I 2.ESTIMATED DUANTT[Y OF I 3.WAS TANK FILLED WITH YES ri NO SUBSTANC`ReAAINING GALLONS INERTMATERIAL? L1 TH(S FORM HAS BE_-- COMPLETED UNDER FENALTY OFPERJURY.AND TO THE SES70FMY KNOWLErJG�IS TRUEAN CORRE- C b7oREASr NAME OATS MRrJTED S SIGNATURM i19A LOCAL AGENCY USE ONLY THE STATE LD.Nu ER IS C016QED OF THE FOUR NUMBERS BELOW COUNTY* JURISDICTION x FACILITY Y a 7 TANK A STATE I.D:n OA �' BJSJ PESAST NUMBER PERMIT PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PEAMff TION.FORMA,UNLFFSS A CURRENT FORMA HAS 13EBI �, Dg TBE COMPLETEDFOR QISTALLATIONS.THIS WRY. SHOULD SEA=MPANIM13YA RLETHLSFORMWfiHTHELOCALAGENCYNPLBIBff1MUNOSTORAGETANKAEMLATIONS M-AU R r8-0--n