COMPLIANCE INFO_1985-1996 - Laserfiche WebLink

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^`�VYwCtt STATE OF CAUFDRICA SATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B t: ° CCIP=ic A SEPARATE FORM FAR EA ANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 ti"`IEWAL PEAMIT 5 CHANGE OF INFORMATION Q 7 PEAMANENTLY ONE REM ❑ 2 INTERIM PERMIT ❑ a AUENOEO PERMIT ❑ 8 TEMPORARY TANK CLOSURE Q 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS-vs--y r-UNKNOWN / 3J A.OWNERS TANK L O.S B. MANUFACTURED BY: C. DATE INSTALLED(MCOAYNEAR) 0.TANK CAPACITY IN GALLONS: 11.TANK CONTENTS IFA-1 ISMARKEO.CO PL---' A. ❑ I MOTOR VEHICLE FUEL a O� S ❑ is REGULAR I� 4 DIESEL Q 6 AVIATION GAS ❑ 2 PETROLEUM Q 80 � 1 PRODUCT ❑ PAEMfUM I}�-(;�VETFUEL 7 METH :L 3 CHEMICALPRCOUCT ❑ 95 UNK`cwN 02 WASTE ❑ 2 LEADED OTHER (DESCRIBE IN ITEM O.BELOW) 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANC 3--RED C.A.S.s: 111. TANK CONSTRUCTION MARK ONE ITEM DNLY2130XES A.B.AND C.AND ALL THAT APPLIES IN BOX 0 A. TYPE OF ❑ 1 DOUBLE WALL (- 3 sNa-c WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM 2' SINGLE WALL C a SECONDARY CONTAINMENT (VAULTED TANK) ❑ Eei I BARE STEEL ❑ 2 SA AN4=SS STEEL ❑ 3 FIBERGLASS C MMPATII3 Ca)i Pt 1S T IC B. TANK MATERIAL ❑ 5 CONCRETE S ?CLYVINYL CHLORIDE I� 7 ALUMINUM ❑ �3 =t (Primary Tank) ❑ 9 BRONZE Z GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER Q I RUBBER LINED ❑ 2 AxYD LNiNr. SPOXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING ❑ 5 '--A:VED R/95 UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE Ygo-A SOT.ME iNANOL? YES_ D.CORROSION ❑ 1 POLYETHYLENE WRAP C 2 COATING =V3 NYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION F! 31 NCNE NKNOWN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IFABOVE^ZXXMOR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A 3 2 PRESSURE A U 3 GRAVITY A U 99 OTHER d. CONSTRUCTION A U 1 SINGLE WALL A 3 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARE STEEL A Z 2 STAINLESS STEEL A U 3 POLYVINYL CHLORICE(PVC)A U a FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A 3 8 CONCRETE A U 7 STEELW(COATING A U 8 100% METHANOL COMPATIBL'VI/FRP PROTECTION A U 9 GALVANIZED STEEL A 3 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER ERSnTIAL il 0. LEAK DETECTION C:] I AUTOMATIC LINE LEAK OE-�-,MR L-_�] 2 LINE TIGHTNESS TESTING ,,0NITORNG Q N OTHER V.TANK LEAK DETECTION ❑ t VISUAL CHECK ❑ 2 INVENTORY RECCN=ATICN f73 VAPOR MONITORING❑ a AUTOMATIC TANK GAUGING F] 5 GROUND WATER MONITORING ❑ B TANK TESTING ❑ 7 INTERSTtTTALM0wfC7Mf+ ❑ 91 NONE ❑ 95 UNKNOWN Q 99 OTHER VI.TANK CLOSURE INFORMATION I.ESTIMATED DATE LAST USED(MO/DAY/YR) 1 Z SSTMATED OUANTITY OF 3.WAS TANK FILLED WITH YES ❑ N0❑ SUBSTANCE REMAINING GALLONS I INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER P?YALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAME DATE (MINTED a SMNATURM '}�} LOCAL AGENCY USE ONLY THE STATE LD.NEER IS COMPOSED OF THE FOUR NUMBERS BELOW v COUNTY,.- JURISOICTIqyx FACILITY TANK x STATE I.D.rrf F7,71, i PEAMIT NUMBER j?--::UIT APPROVED VIOATE I PERMIT EXPIRATION DATE, FORM 8 (9.90) THIS FORM MUST BE ACCOMPANIES BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED." F FA=8.a4