COMPLIANCE INFO_1993-1994 - Laserfiche WebLink

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FOR1.4 `E3': UNDJ&GROUND STORAGE TANK PRq RAhII safe' �I� Y jZTAN ERM IT APPLICATION INFORMWION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. MARK ONLY ❑ I"NEW PERMIT ❑3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑7 PERMANENTLY CLOSED TANK ONE ITEM ❑2 INTERIM.PERMIT ❑4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED J ) FACILITY/SITE NAME WHERE TANK IS INSTALLED: Exxon RAS # 7-�(3% FARM TANK-YES❑ NO ❑X 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SCI SPECIFY i C A. OWNERS TANK ID# B. MANUFACTURED BY: C. YEAR INSTALLED D. TANK CAPACITY IN GALLONS: 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A. i MOTOR VEHICLE FUEL ❑2 PETROLEUM B. C. ®1 UNLEADED 2 LEADED ❑3 DIESEL �+ 3 CHEMICAL PRODUCT ❑4 OIL ® i PRODUCT ❑4 GASAHOL 5 JET FUEL 6 AVIATION GAS ❑5 HAZARDOUS ❑80 EMPTY [:]95 UNKNOWN 2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM D.BELOW) D. IF NOT MOTOR VEHICLE FUEL.ENTER NAME OF HAZARDOUS SUBSTANCE STORED&C.A.S.K C.A.S.It: x111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D A.TYPE OF ❑ I DOUBLE WALLED 3 SINGLE WALLED WITH EXTERIOR LINER 95 UNKNOWN SYSTEM! �2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER ©.i STEE&iR0N- O 2 STAINLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CUD W/FIBERGLASS REINFORCED PLASTIC B.TANK 5 CONCRETE Ej 6 POLYVINYL CHLORIDE F-1 7 ALUMINUM Ej 8 100%METHANOL COMFATIBLE FRP MATERIAL 9 BRONZE 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER C.INTERIOR I RUNER LINED 2 AU(YO LINING 3 EPDXY LINING 4 PHENOLIC LINING LINING ❑5 GIASSUN!NG ®6 UNLINED 95 UNKNOWN IS LINING MATERIAL COMPAT18L E WITH 100%METHANOL? YES [:)NO 99 OTHER D.CORROSION ❑I POLYETHLENE WRAP 2 TAR OR ASPHALT 3 VINYL WRAP Ej 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 5 CATHODIC PROTECTION ❑91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND. U IF UNDERGROUND.BOTH IF APPLICABLE X SYSTEM TYPE A U I SUCTION A g 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A ®i SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A ©1 STEEW R6N' A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P S I VISUAL CHECK ©S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P 5 4 ELECTRONIC MONITOR P 5 5 GROUND WATER MONITORING WELLS P 5 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1.ESTIMATED DATE LAST USED(MO/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN INERT MATERIAL? ❑YES NO GALLONS THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,,&A THqfiEST OF MY KNOWLEDGE.JS TRUE AND CORRECT. APPLICANTS ( E) DATE U.G.T. ANALYS7 y LOCAL AGENCY USE ONLY county 4 JURISDICTION#I AGENCY N FACILITY ID 8 TANK ID N [M I I I I I - 1 -1-1 1 1 F_/ lvl -/:)T_7d CURRENT �LOC`ALL AGENCY ,FACILITY • APPROVED BY NAME PHONE•WITH AREA CODE C �i � 7�®/v PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE CHECK• PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT i BY: FORM B(3-7.88) THIS FORM MUST BE ACCOMPANIED BY A FACILITYMTE APPLICATION, FORM 'A',U jW A WNT FORMA' HAS BEEN FILED 06 DATA PROCESSING COPY