COMPLIANCE INFO_1985-1996 - Laserfiche WebLink

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STATE OF CALIFORNIA ��•,�`�' STATE WATER RESOURCES CONTROL BOARD s m g UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B r . o COIF E;E A SEPARATE FORM FOR EA ANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT CV5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: aea I. TANK DESCRIPTION c0 ETEALL ITEMS->xC:FrVUNKNOWN A. OWNER'S TANK 1.0.t B. MANUFACTURED BY: C. OATE INSTALLED(MO/DAY/YEAR) 140 0. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IFA-1ISMAR KE D.CO 4-_—_y C. REGULAR A F-1, 1 MOTOR VEHICLE FUEL 4 OIL B. C. F7 1aUNLEADED }--{ 3 DIESEL ❑ 8 AVIA�.N GAS a 2 PETROLEUM ❑ 80 EMPTY iy i ' PRODUCT lb PREMIUM I—j 4 GASAHOL 7 METHANOL UNLEADED 5 JET FUEL ❑ ❑ 3 CHEMICAL PRODUCT ❑ 95 UNILVCWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM 0.BELOW) 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.S: III. TANK CONSTRUCTION MARK ONE ITEM ONLY-N BOXES A.9.AND c.AND ALL THAT APPLIES IN BOX 0 A. TYPE OF V�� BLE WALL 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM LE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTEDTANK) ❑ 99 OTHER B. TANK 1 BARE STEEL F72 STAINLESS STEEL ❑ 3 FIBERGLASS F] 4 STEEL CLAD WI FIBERGLASS REINFORCEO PLASTIC MATERIAL ❑ 5 CONCRETE C S POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE WIFRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING F—! 3 UNLINED UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE V T H IOD%METHANOL? YES_ No D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ,❑._, 3 NYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION F-1 91 NONE i .I 1% UNKNOWN ❑ 99 OTHER GR IV.PIPING INFORMATION CIRCLE A IF ABOVE OUNOOR U IF UNDERGROUND.BOTH IFAPPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER S. CONSTRUCTION A U 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 U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORICE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEEL Wl COATING A U 8 100%METHANOL COMPATIBLE WfFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ i AUTOMATIC LINE LEAK OE,---CMR 2 UNE TIGHTNESS TESTING ❑ 3 yOINTENRORING ❑99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY REC NCiaTICN ❑ 3 VAPOR MONITORING C] 4 AUTOMATIC TANK GAUGING❑ 5 GROUND WATER MONITORING ❑ 8 TANK TESTING ❑ 7 INTERSTITTAL.MOMIORWG C:] 91 NONE El95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAYNR) 12.ESTIMATED OUANTITY OF 3.WAS TANK FILLED WITH YES NO I SUBSTANCE REMAINING GALLONS INERT MATERIAL? C—] ❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAME DATE h 1PRNTE0 4 SIGNATUFU Q U LOCAL AGENCY USE ONLY THE STATE LD.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW v �� COUNTY s JURISOICTIQM# FACILITY f TANK# STATE I.DJ PERMIT NUMBER f -RMIT APPROVED alfiwe PERMIT EXPIRATION DATE FORM B (9.90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORD¢ &PA