COMPLIANCE INFO_1989-2001 - Laserfiche WebLink

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eNun t 'fIV�1 C7 STATE OF CALIFORNIA t. STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 COMPLETE A SEPARATE FORM FOR 5p TANK SYSTEM. MARK ONLY CI 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ,1 8 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 1/0„� {# !�-Z-7 S I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# - B. MANUFACTURED BY: C,J Q ws C. DATE INSTALLED(MO/DAYNEAR) (� D. TANK CAPACITY IN GALLONS: ^v o II.TANK CONTENTS IFA-1 IS MARKED.COMPLETE ITEM C. ® 1 MOTOR VEHICLE FUEL F74 OIL e. C El1aUNLEA ED El 3 DIESEL ❑ g AVIATION GAS REGULAR A F72 PETROLEUM F780 EMPTY ® 1 PRODUCT F7tb PREMIUM 4 GASAHOL W117-METHANOL UNLEADE ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED D F7 5 JET FUEL 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.# III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK ❑ 1 BARE STEEL 2 STAINLESS STEEL 3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE 8 POLYVINYL CHLORIDE 7 ALUMINUM 8 100% METHANOL COMPATIBLE W/FRP (PrimaryTank) ❑ 9 BRONZE 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR 5 GLASS LINING 6 UNLINED ❑ 95 UNKNOWNF799 OTHER LINING u '41 IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES NO_ D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ® 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) I l OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) 14 9 IV. PIPING INFORMATIO14 CIRCLE A IFABOVE G NO OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A 1 CTION Y?/ 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A 1 SINGLE WALL JT 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 O 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/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 ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING MONITORING ❑ 99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK & 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 6 TANK TESTING `Y" 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAYNR) 2 ESTIMATED SUBSTANCE QUANTITY OF LONS 3.WAS TAN FILLEDMATERWITH YES j NO REMAu THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, N Tg T4 BE F MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME . DATE (PRINTED d SIGNATURE) �n v, J T 4}NS o 7- f4 - f3 LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE UR iuMBERS BELOW COUNTY# JURISDICTION# �A6WIY�#t' TANK# {� STATE I.D.# !� PERMIT NUMBER ( PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION.FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. G� FILE THIS FORM WITH TH LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STOLE FORM 8 (12-91) TANK REGULATIONS FOR00348-R6 ;�' pq"Y-S5�el'