COMPLIANCE INFO_1993-1998 - Laserfiche WebLink

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• � c ,�`:r -�""` "-c- `.-._".-T ,-..."--m �...-.•-•.,.•.._.,'fix+ ^--z �"r.'.,°`-'�.^�^-='-z��-�-^^-,'^'--� '*---� STATE OF CALIFORNIA I STATE WATER RESOURCES CONTROL BOARD a ' -- UNDERGROUND STORAGE TANK PERMIT APPLICATION-FORM B 4 ° COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY F-] 1 NEW PERMIT 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION7 RMANENTLY CLOSED QNSITE -- k ONE ITEM 2 INTERIM PERMIT 0 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE B TANK REMOVED j DBA OR FACILITY NAME WHERE TANK IS INSTALLED: £'7 *T ly 47-7 /3 v I. TANK DESCRIPTION --------C��O^^^M��-PLETE ALL ITEMS-- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# { B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR) D. T'NK CAPACITY IN GALLONS: ILTANKCO TENTS IFA-1 IS MARKED,COMPLETE ITEM C. I 1 MOTOR VEHICLE FUEL 4 OIL B. a REGULAR 3 DIESEL A. C' UNLEADED 6 AVIATION GAS k. 2 PETROLEUM 60 EMPTY [ t PRODUCT O lb PREMIUM 4 GASAHOL 7 METHANOL UNLEADED 5 JETFUEL 3 CHEMICAL PRODUCT 95 UNKNOWN 2 WASTE 0 2 LEADED gg OTHER (DESCRIBE IN ITEM D. BELOW) D. IF A.1 IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED ( ) C.A.S.#: f` III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALLTHAT APPLIES IN BOX D AND E A. TYPE OF F-] 1 DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER a 95 UNKNOWN SYSTEM SINGLE WALL 4 SECONDARY CONTAINMENT (VAULTED TANK) O 99 OTHER B. TANK li� l BARE STEEL F-] 2 STAINLESS STEEL F7 3 FIBERGLASS a 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL 0 5 CONCRETE F-1 6 POLYVINYL CHLORIDE F_� 7 ALUMINUM a 6 100°/ METHANOL COMPATIBLE W/FRP (Primary Tank) 9 BRONZE 10 GALVANIZED STEEL [:] 95 UNKNOWN 99 OTHER 1 RUBBER LINED 2 KYD LINING F-] 3 EPDXY LINING 4 PHENOLIC LINING C.INTERIOR 5 GLASS LINING NLINED F-1 95 UNKNOWN F__] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO D.CORROSION 0 1 POLYETHYLENE WRAP F-] 2 COATING 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [-] 5 CATHODIC PROTECTION ❑ 91 NONE5 UNKNOWN 99 OTHER E,SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A�U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER ~' B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A(V 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U S 100% METHANOL COMPATIBLE W/FRP PROTECTION A U GALVANIZED STEEL A U 10 CATHODIC PROTECTIONA U 95 UNKNOWN A p 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING 3 INTERSTI IAL MONITORING ❑ 99 OTHER ( V.TANK LEAK DETECTION r 1 'VISUAL CHECK a 2 INVENTORY RECONCILIATION F-] 3 VADOZE MONITORING 0 4 AUTOMATIC TANK GAUGING 5 GROUNDWATER MONITORING jM TANK TESTING 0 7 INTERSTITIAL MONITORING 91 NONE 95 UNKNOWN 99 OTHER a VI.TANK CLOSURE INFORMATION 1.ESTIMATED f7A E LAS�TE10/DAY YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES NO "c C5 SUBSTANCE REMAINING GALLONS INERT MATERIAL? tm THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME . \ DATE $INTE(�SIGNATURE) ' +--. LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# p STATE LD.# I I L I J PERMITNUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION FORM A,UNLESS A CURRENT.FORM A HAS BEEN FILED. 4&0034B-RS , a Y ,1 t "�... M1 4 ^, k ; ry> .y rP,�, .+ �' �� ^ 'r_ �' ?"'yr .�i•!• :'°�F� .,,a*i. #' ,. }= .�.,�,` <.�.ar;e��..�': -'` ,.��'.J `x. uw>bw. yku wex.I � .. �r.• .ta �K-_�" ,.