COMPLIANCE INFO_1997-2002 - Laserfiche WebLink

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0 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD tlye UNDERGROUND STORAGE TANK PERMIT APPLICATION-FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY F-1 I NEW PERMIT F-1 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ONE ITEM D 2 INTERIM PERMIT 0 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE F-1 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: L, PIL, L\ L\7 I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNERS TANK 1.0.# B. MANUFACTURED BY: Nj L\N 6 h)b�k� W C. DATE INSTALLED(MOIDAYNEAR) 4 D. TANK CAPACITY IN GALLONS: (Y)n II. ANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. A. g I MOTOR VEHICLE FUEL E] 4 OIL EL C. la REGULAR UKEADEDH 3 DIESEL 0 6 AVIATIONIGAS F__j F_� 2 PETROLEUM ❑ 80 EMPTY t!�_l PRODUCT ❑ lb PREMIUMLKEADED ❑ 4 GASAHOL F__j 7 METHANOL 3 CHEMICAL PRODUCT 95 UNKNOWN 2 WASTE Ic MIDGRADE UNLUDED F_j 5 JET FUEL f__1 8 M85 E] F2 LEADED El 99 OTHER(DESCRIBE W M D.8B.0M D. IF(A.1)IS NOT MARKED, EWER NAME OF SUBSTANCE STORED CAS#: Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C,AND ALL THAT APPLIES IN BOX 0 AND E A. TYPE OF [:j 1 DOUBLE WALL ❑ 3 SINGLE WALL wTH EXTERIOR LINER ❑ 5 INTEFINAI.BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM 01,2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT 0 99 OTHER B. TANK F__j I BARE STEEL ❑ 2 STAINLESS STEEL 3 FIBERGLASS Q 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM F__j 8 100% METHANOL COMPATIBLEWIFFIP Phn"Tank) ❑ 9 BRONZE E] 10 GALVANIZED STEEL ❑ 95 UNKNOWN E] go OTHER C.INTERIOR F__j I RUBBER LINED ❑ 2 ALKYD LINING f__j 3 EPDXY LINING ❑ 4 PHENOLIC LINING LINING OR F-1 5 GLASS LINING 6 UNLINED ❑ 95 UNKNOWN 99 OTHER COATING M, IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO— D.EXTERIOR F__j I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP F__j 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION ❑ s CATHODIC PROTECTION D!a 91 NONE 95 UNKNOWN 99 OTHER E SPILL AND SPILL CONTAINME��STALLED(YEAR)_L -J_0 PLATE SRFILL PREVENTION EQUIPMENT INSTALLED OVERFILL BIC' DROP T NO STRIKER =;L,= NO— DISPENSER IME M EWE! NO IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION AU)2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION AOU 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 CHLORIDE(PVC)A&S 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U s i00%METHANOL compAnBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 0' mEAL uNE LEAK0 2 UNE TrAiTWW 3 NTEPSTMAL UK �=TIC OMffMXM aEcrR= IZRw 0 99 OTHER GE*mcWOR_ TESTM.......... MONTOFM LEAK DETECM ER V.TANK LEAK DETECTION 4 AUTOMATIC TANK F__j 5 GROUND WATER 6 ANNUALTANK I VISUAL CHECK L__j ING MONITORING 0 2 MANUAL INVENTORY ❑ 3 VADOZE 7 CONTINUOUS INTERSTITIAL RECONCILIATION MONITOR GAUGING TESTING MONITORING 8 SIR 9�y MANUAL 10 MONTHLY TANK F_� 95 UNKNOWN K r2lNG TESTING El 99 OTHER VI. ANK CLOSURE INF ORMATION(PERMANENT CLOSURE IN-PLACE) LESTIMATED DATE LAST USED(MOIDAYNR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL? YES ® NOE] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT I TANK OWNERS NAME DATE 17 INTED&SIGNATUR% rw LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMB BELOW COUNTY# JURISDICTION# FACILITY It TANK# STATE I.D.4 m Li--L-j TF PERMIT NUMBER PERMIT APPROVED El I 1 11 T1 BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS.THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORMS (6-96)