COMPLIANCE INFO_1987-1998 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORN WATER RESOURCES CONTROARD FORM V: UNDE GROUND STORAGE TANK PRIRAM _ o TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. " �^� 7 MARK ONLY ❑ 1 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 , FACILITY/SITE NAME WHERE TANK IS INSTALLED: BP 0 i 1 Company Fa ' 1 i ty Site #1,1191 FARM TANK - YES ❑ NO 'ANK DESCRIPTION COMPLETE ALL ITEMS - IF UNKNOWN - SO SPE IFY A. OWNERS TANK ID # Unknown B. MANUFACTURED BY: Unknown C. YEAR INSTALLED 1984 D. TANK CAPACITY IN GALLONS: 6, 000 II. TANK CONTENTS IF (A.1). IS MARKED. COMPLETE ITEM C. IF (A.11. IS NOT MARKED. COMPLETE ITEM D. A. ® 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM B. C. 1 UNLEADED 2 LEADED X®3 DIESEL ❑ 3 CHEMICAL PRODUCT ❑ 4 OIL ❑X 1 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. # C.A.S. #: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A, B, C, & D A. TYPE OF ❑ 1 DOUBLE WALLED ❑ 3 SINGLE WALLED WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM X❑ 2 SINGLE WALLED ❑ 4 SECONDARY CONTAINMENT ❑ 99 OTHER U 91 NONE A U 95 UNKNOWN A U 99 OTHER F-11 STEEL/IRON ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS F-]4 STEEL CLADW/FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL F-15 CONCRETE ❑ 6 POLYVINYL CHLORIDE F-]7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE FRP BY: ❑ 9 BRONZE 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER A F-]1 RUBBER LINED ❑ 2 ALKYD LINING F-13 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR LINING ❑ 5 GLASS LINING X❑ 6 UNLINED A ❑ 95 UNKNOWN 7 STEEL CLAD W/FRP ❑ IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? ❑ YES ❑ NO ❑ 99 OTHER D. CORROSION ❑ 1 POLYETHLENE WRAP ❑ 2 TAR OR ASPHALT ❑ 3 VINYL WRAP ❑ 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 A. SYSTEM TYPE A U 1 SUCTION ALW 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B. CONSTRUCTION AU 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER BY: A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) AlQ 4 FIBERGLASS PIPE A U 91 NONE 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. pS I VISUAL CHECK +1S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND %VAATTER MONITORING WELLS b)6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P 9 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 FACILITY ID # TANK ID # SUBSTANCE REMAINING IN INERT MATERIAL? [:]YES ❑ NO APPROVED BY NAME PHONE # WITH AREA CODE 6 GALLONS THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT. LOCAL A( APPLICANT'S NA E (PRINTED & SIGN DATE W. J. Hollis Ma 31 1989 !F -NCV USE O COUNTY # JURISDICTION # AGENCY # 1161011111�d:&][ FACILITY ID # TANK ID # CURRENT LOCAL AGENCY FACI ITY ID # hz"C//JJ�� APPROVED BY NAME PHONE # WITH AREA CODE 6 PERMIT NUMBER PERMIT APPROVAL DATE f I QtRMIT EXPIRATION DATE CHECK # PERMIT AMOUNT SURCHARGE AMT. FEE CODE iiiRECEIPT # BY: FORM B (6-29-88) 1111115 FURM MUST UE AccUMPANIE6r A FACILITY/SITE APPLICATION, t U H MI -A-, UNLESS A CURRENT FORM `A' HAS BEEN FILED DATA PROCESSING COPY 10