COMPLIANCE INFO_1986-1996 - Laserfiche WebLink

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STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD s �} UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B w a >a o ha COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY Fv� 1 NEW PERMIT ❑ 3 RENEWAL PERMIT FX7 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ARC) Facility 548 © 3 FIBERGLASS I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # Unknown B. B. MANUFACTURED BY: Xerxes ❑ 2 PETROLEUM ❑ 80 EMPTY C. DATE INSTALLED (MO/DAY/YEAR) 95 D. TANK CAPACITY IN GALLONS: 10,000 ❑ 2 WASTE II. TANK CONTFNTS IFA -1 IRMARKFnrnmpIPTP ITFMC A. ® 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C ❑ la REGULAR ❑ 3 DIESEL ❑ 6 AVIATION GAS UNLEADED ❑ 4 GASAHOL ❑ 2 PETROLEUM ❑ 80 EMPTY FX] 1 PRODUCT ® lbPREMIUM 7 METHANOL UNLEADED ❑ 5 JET FUEL ❑ ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. # III- TANK CONSTRUCTION MARK nNF ITEM nNl YIN RnYFS A R ANn(: ANn AI I TWAT APPI Icc IN GIIV n Anln c A. TYPE OF [X� 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK F—]1 BARE STEEL F—]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 (PrimaryTank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED F—]2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR LINING ❑ 5 GLASS LINING ® 6 UNLINED El95 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 CATHODIC PROTECTION ® 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) 95 OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) 95 IV. PIPING INFORMATION CIRCLE A IF ARovF GRntjNn oR D IF I1NnFRC;Rl711Nn RnTI-I IF APPI ICARI c A. SYSTEM TYPE A U 1 SUCTION p 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL Ad) 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION A U A U A U 1 BARE STEEL 5 ALUMINUM 9 GALVANIZED STEEL A U A U A U 2 STAINLESS STEEL A U 6 CONCRETE A U 10 CATHODIC PROTECTION 3 POLYVINYL CHLORIDE (PVC) A © 4 FIBERGLASS PIPE 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLE W/FRP A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION X] 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3INTERSTITIAL MONITORING [1] 99 OTHER V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK ® 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUNDWATER MONITORING ❑ 6 TANK TESTING LX] 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES ❑ NO ❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN C PLETED UNDER P A OF PERDU AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAM DATE (PRINTED 8 SIGN U E) Thomas Schoenstein 5/23/95 LIJLHL AUtNt, T UJt kJNLT I Ht 51 AI E W. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW V./ J COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# ❑ v -5 b' PERMIT NUMBERPERMIT APPROVED BY/DATE I P RMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION • FORMA, UNLESS A CURRENT FORMA HAS BEEN FILED FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (12-91) 0 0 FOR00346-116