COMPLIANCE INFO_1993-1998 - Laserfiche WebLink

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STATE OF CALIFORNIA • ? P STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B�, COIUDI FTF A CFDADATF FODMI Pnl) CAr'W TAAWV CVQTC". MARK ONLY ❑ 1 NEW PERMIT O 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON ITE ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED , DBA OR FACILITY NAME WHERE TANK IS INSTALLED: It TN r,,PF- Fr7"r C40&YtFc) III I. TANK DESCRIPTION COMPLETE ALL ITEMS •• SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # B. MANUFACTURED BY:, C. DATE INSTALLED (MO/DAY/YEAR) ll� 11!2 D. TANK CAPACITY IN GALLONS: ( p 0 Q II_TANKCONTENTS IF A.11.RMARKFD. COMPLFTF ITEM C. r7 Fl-Olc-., I )eII I-A0C'Iii A a1 MOTOR VEHICLE FUEL 4 OIL B- C- ❑ 1aUN LE 3 DIESEL 6 AVIATION GAS ❑ REGULAR 4 GASAHOL ❑ 2 PETROLEUM ❑' 80 EMPTY , I' PRODUCT E tb PREMIUM ❑ 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 ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D AND F A. TYPE OF E T 1 DOUBLE WALL Q 3 SINGLE WALL WITH EXTERIOR LINER � 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) 99 OTHER B. TANK El 1 BARE STEEL F72 STAINLESS STEEL :3 FIBERGLASS 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL ''��II FD 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM E�:] 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER 1 RUBBER LINED 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR F-]5 GLASS LINING EE 6 UNLINED F-195 UNKNOWN El99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES NO D. CORROSION 1 POLYETHYLENE WRAP ❑ 2 COATING F7 3 VINYL WRAP [:1'4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE F-] 95 UNKNOWN F-] 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A(U-1 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL AFV2 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''U,; 7 STEEL W/ COATING A U A U 95 UNKNOWN A U 4 FIBERGLASS PIPE 8 100% METHANOL COMPATIBLE W/FRP 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3 INTERSTITIAL MONITORING L-99 OTHER V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 -INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 6 TANK TESTING T INTERST1TfAL1ifONtTORIM0." ❑ .81. NONE -]95 UNKNOWN ❑ 99 OTHER VI. TANK CLOSURE INFORMATION . CCTIAI-ATCM nATC 1 ACT I ICCM 11..Vl/nAVN01 AC TAAIV CII I — %A—I J _. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME DATE (PRINTED B SIGNATURE)( IY�A/�wp'(�'J - C, 1ovF-0� _ LOCAL AGENCY USE ONLYL/ d THE ISTATE I.D. NUMBER IS COM'TPOSED OF THE FOUR 4UMBERS BELOW �f i COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# mI IK I P I' PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE- / ✓ FORM R. (7-9t) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR0034&R5