COMPLIANCE INFO_1991-2004 - Laserfiche WebLink

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STATE OF CAUFOF44A STATE WATER RESOURCES CONTROL BOARD a 0 UNDERGROUND STORAGE TANK PERMIT APPLICATION-FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT F--j 3 RENEWAL PERMIT F-] 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY v'ol'tCMLITE ONE ITEM 2 INTERIM PERMIT F-� 4 AMENDED PERMIT F-� 8 TEMPORARY TANK CLOSURE E] 8 TANK REMOVE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ckelv'ol't kx!�-N 0i 1. TANK DESCRIPTION COMPLETE ALL ITEMS-SPECIFY IF UNKNOWN / A. OWNERS TANK I.D.a -L I B. MANUFACTURED BY: IC)VJ eAl S C. DATE INSTALLED(MO(DAYIYEAR) 'q I q I I D. TANK CAPACITY IN GALLONS: ta, Goo 11.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. to REGULAR 3 DIESEL F--j 6 AVIATION GAS A. ;K� 1 MOTOR VEHICLE FUEL F-14 OIL B. C.. el UNLEADED r7 2 PETROLEUM F-1 so EMPTY I PRODUCT lbPREMIUM 4 GASAHOL E:] 7 METHANOL UNLEADED 6 JET FUEL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE 2 LEADED H 99 OTHER (DESCRIBE IN ITEM D. BELOW) 10 D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C.AND ALL THAT APPLIES IN BOX D A. TYPE OF 1 DOUBLE WALL F-] 3 SINGLE WALL WITH EXTERIOR LINER F7 95 UNKNOWN A SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) F--j gg OTHER B. TANK ❑ 1 RARE STEEL E] 2 STAINLESS STEEL >g 3 FIBERGLASS 7 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL F--j 5 CONCRETE F-1 6 POLYVINYL CHLORIDE1® 7 ALUMINUM F--] 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) [—] 9 BRONZE E] io GALVANIZED STEEL [:] 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING F-1 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING 6 UNLINED ❑ 96 UNKNOWN F--j 99 OTHER LINING IS LINING MATERIAL COMPATIS6 WITH 100%METHANOL? YES— NO D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 0 5 CATHODIC PROTECTION E] 91 NONE E:]96 UNKNOWN E] 99 OTHER IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE ASI SUCTION A67 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U i SINGLE WALL AdD 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 U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A(!D4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WICOATING A U 8 100% METHANOL COMPATIBLEWIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR [:] 2 LINE TIGHTNESS TESTING 3 IMNOTMTRINGIAL ITF]99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING❑ 4 AUTOMATIC TANK GAUGING❑ 6 GROUND WATER MONITORING ❑ 6 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 96 UNKNOWN ❑ 99 OTHER 1 VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING (:—'�LONS INERT MATERIAL? YES [:] NO F❑D THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PER Y,AND "8 M KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAMETE (PRINTED A SIGNATURE)Imim Cxr DA LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FLUR NUjBERS BELO� COUNTY# JURISDICTION# If FACILITY—# TANK# STATE I.D.# = 101013 olo-laki3i PERMIT NUMBER PERMIT APPROVED BY/DATE PtRMIT 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. FDROM04141