COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

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STATEOFCAUFOMdA w , STATE WATER RESOURCES CONTROL BOARD W 74 UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B COMPLETE A SEPARATE FORM FORTANK SYSTEM. MARK'ONLY ❑ 1 NEW PERMIT ® 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PER MAN SE ON ..E ONE ITEM ❑ 2 INTERIM PERMIT ❑ d AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK R9—M':) DBA OR FACILITY NAME WHERE TANK IS INSTALLED: j=j j2e_o F-A` a,Lo. OE;14 1. TANK DESCRIPTION COMPLETE ALL ITEMS— SPECIFY IF UNKNOWN A. OWNER'S TANK 1.0.* L4—UML– F I B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR) o /�� D. TANK CAPACITY IN GALLONS: 000 11.TANK CONTENTS IFA-IISMARKED,COMPLETE ITEM C. A. LJ i MOTOR VEHKxE FUEL ❑ 4 OIL B. C ❑ IaREGULAR UNLEAED F7 3 DIESEL ❑ 5 AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY CI�1 PRODUCT PREMIUM L- 4 CA SAHOL �� METHANOL UNLEADED 5 JET FUEL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 1 99 OTHER (DESCRIBE IN ITEM D. BELCWI 0. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.s: 111• 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 �f2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER L B. TANK � 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLAS^C MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 106% METHANOL COMPATIBLE W%FSP (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 LINING ❑ 5 GLASS LINING C� UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER 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 CATHOOICPROTECTION ❑ 91 NONE Cyf95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EOUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.SOT14 IF APPLICABLE A. SYSTEM TYPE A U I SUCTION A 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 AID 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 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WiFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ERi AUTOMATicUNE LEAK DETECTOR [21LINE TK;HTNESS TESTING ❑ RORiNK; ❑gg OTHER V.TANK LEAK DETECTION �1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WA i cR MONITCR;NG C1�6 TANK TESTING ® 7 INTER8TITIALMONrrORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER Vi.TANK CLOSURE INFORMATION LES DATE LAST USED(MO/OAY/YR) ( 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES 1- NO LES SUBSTANCE REMAINING GALLONS I INERT MATERIAL? — THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE B T OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME (PRINTED a SIGNATURE) DATE A Z•Zl•gZ LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OFTHE F R NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK x ,I STATE Jjjf013 /7i PERMIT NUMBER I PERMIT APPROVED BY/DATE I 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. FOROa118-RS