COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

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41,U" nS STATE OF CALIFORNIA :��"t STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B COMPLETE A SEPARATE FORM FOR EYH TANK SYSTEM MARK'ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT Es�ss CHANGE OF INFORMATION ❑ 7 PERM�EJPOD / 'DON Y ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT TEMPORARY TANK CLOSURE ❑ 8 TAN DBA OR FACILITY NAME WHERE TANK IS INSTALLED: t4 24.0 F'qL sLv, I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK 1.O.# 2-L)klL-P. I B. MANUFACTURED BY: 0"K1,,4 O(.,k4 C. DATE INSTALLED(MO/DAY/YEAR) ®S/_/&40 0. TANK CAPACITY IN GALLONS: L4,000 II.TANK CONTENTS IF:A-1 IS MARKED.COMPLETE ITEM C. A. C1� MOTOR VEHICLE FUEL ❑ 4 OIL g, C. C�U IEA REGULARI 3 DIESEL ❑ 6 AVIATION GAS 2 PETROLEUM ❑ 80 EMPTY �t PRODUCT ❑ tb PREMIUM 4 GASAHOL ❑ 7 METHANOL UNLEADED 5 JET FUEL 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM 0. SELOWI 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.o III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C.AND ALL THAT APPLIES IN BOX 0 AND E A. TYPE OF ❑ it DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM {❑11 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ® 99 OTHER B. TANK L-� 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ® 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER 1 RUBBER LINED ® 2 ALKYO LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR r"I 5 GLASS LINING �6 UNLINED ❑ 95 UNKNOWN ❑ N OTHER LINING —1 IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES_ NO D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING E❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONEI✓SSS 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 IFUNDERGROUNO.30THIFAPPLICABLE A. SYSTEM TYPE A U 1 SUCTION U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION Ao 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 U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEEL W/COATING A U 8 1009; METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER 0. LEAK DETEC710Nt AUTOMATIC UNE LEAK DETECTOR C 2'LINE TIGHTNESS TESTING ❑ F�NIiORING ❑ 99 OTHER V.TANK LEAK DETECTION E1 VISUAL CHECK ❑Ij 2 INVENTORY RECONCILIATION ❑ 3 VAOOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING❑ 5 GROUND WATER MONITORING TANK TESTING ❑ 7 INTERSTITIAL MONITORING 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER Vi.TANK CLOSURE INFORMATION i.ESTIMATED DATE LAST USED(MO/DAYNR) 2.ESTIMATED OUANTITY OFI 3.WAS TANK FILLED WITH YES NO SUBSTANCE REMAINING REMAINING GALLONS L INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME JOA (PRINTED&SIGNATURE) > e—w til Z -7-1.q L LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NU ERS BELOW 61 „,�►:a- COUNTY;# JURISDICTION# FACILITY# TANK# STATE LD.# I PERMIT NUt.IBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE ! FORMS (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FOROM48•R5