COMPLIANCE INFO_1985-1996 - Laserfiche WebLink

Home Browse Search

,agOuweet STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION w FORM B ol COW—c TE A SEPARATE FORM FOR EA ANK SYSTEM MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ft�4 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLQSZQeWSqE ONE ITEM ❑ 2 INTERIM PERMIT ❑ a AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: . ) 2� L TANK DESCRIPTION COMPLETE ALL ITEMS-SPECFY IF UNKNOWN A. OWNER'S TANK I.O.s 13. MANUFACTURED BY: C. DATE INSTALLED(MOIDAYNEAR) 0.TANK CAPACITY IN GALLONS: II.TANK CONTENTS IFA-1 ISMARKED.Co mri—EyC. ff��tt A. ❑ t MOTOR VEHICLE FUEL a Oil 9. C. ❑ 78UNLEUADE� 3 DIESEL ❑ 6 AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY 1 PRODUCT ❑ Ib PREMIUMUNLEADEVJET F 0 7 METHANOL 3 CHEMICAL PRODUCT ❑ 95 UPOLVCWN ❑ 2 WASTE ❑ 2 LEADED HER (CESCRIBE IN ITEM 0.BELOW) D. 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.B.ANO C.AND ALL THAT APPLIES IN BOX 0 A. TYPE OF FV-11, DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER E-7195 UNKNOWN SYSTEM SINGLE WALL ❑ • SECONDARY CONTAINMENT (VAULTED TANK) ❑I 99 OTHER B. TANK rvi t BARE STEEL F72 STAINLESS STEEL F73 FIBERGLASS El STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ S POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE WIFRP (Primary Tank) ❑ 9 BRONZE ❑I 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYO LINING `EPDXY LINING ❑ a PHENOLIC LINING C.INTERIOR F-15 GLASS LINING ❑ 5 UNLINED 95UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES_ _ D.CORROSION ❑ 1 POLYETHYLENE WRAP , 2 COATINGVUNKNOWN NYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODICPROTECTION F7 91 NONE ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U i SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 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 CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI 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 D. LEAK DETECTION ❑ I AUTOMATIC LINE LEAK DE-ECTOR ❑ 2 UNE TIGHTNESS TESTING ❑ 3 1DNROW ❑99 OTHER LTAAKDETECTION UAL CHECK 2 INVENTORY RECCNM ATION ❑ 3 VAPOR MONITORING❑ 4 AUTOMATIC TANK GAUGING❑ 5 GROUND WATER MONITORING NK TESTING ❑ 7 INTERSTITIALMON117ORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MOIDAYNR) 2 ESTIMATED OUANTITY OF 3.WAS TANK FILLED WITH YESNO SUBSTANCE REMAINING GALLONS I INERT MATERIAL? ❑ ❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, 1S TRUE AND CORRECT APPLICANTS NAME DATE (PwnTED a SIGNATURE) 6 LOCAL AGENCY USE ONLY THE STATE LD.14MER IS COMPOSED OF THE FOUR NUMBERS BELOW vJ COUNrs JURISOICTIQN FACILITY TANK sF STATE LD.;# E PERMIT NUMBER ---;MfT APPROVED VIOATE I PERMIT EXPIRATION DATE FORM 8(9.90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORORIt6 7t 0 ��