COMPLIANCE INFO_1998-2006 - Laserfiche WebLink

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w STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY C SI ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 1 *71 I. TANK DESCRIPTION COMPLETE ALL ITEMS SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # B. MANUFACTURED BY: )(le"t"52b C. DATE INSTALLED (MO/DAYNEAR) It 1 a KD. TANK CAPACITY IN GALLONS:pw lclow II- TANK CONTENTS IF A-1 IS MARKED. COMPLETE ITEM C. A. ❑ 1 MOTOR VEHICLE FUEL ❑ 4 OIL ❑ 80 EMPTY B. 1 PRODUCT C ^'E-_ la REGULAR UNLEADED ❑ 3 DIESEL ❑ 6 AVIATION GAS E]1b PREMIUM UNLEADED ❑ 4 GASAHOL ❑ 7 METHANOL ❑ 2 PETROLEUM SYSTEM F-1lcMIDGRADE UNLEADED ❑ 5 JET FUEL ❑ 8 M85 ❑ 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 E A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL DD 3 FIBERGLASS ❑ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLEW/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C. INTERIOR ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING LINING OR ❑ 5 GLASS LINING ER 6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100°/6 METHANOL? YES— NO— D. EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑ 95 UNKNOWN E:]99 OTHER PROTECTION tews E. SPILL AND OVERFILL, BtC. SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) DROP TUBE YES <' NO STRIKER PLATE YES. -::moi. NO DISPENSER CONTAINMENT YES NO IV. PIPING INFORMATION CIRCLE A IF ABOVE $ROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A V2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING 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 CORROSION PROTECTION A U A U A U 1 BARE STEEL A U 5 ALUMINUM A U 9 GALVANIZED STEEL A U 2 STAINLESS STEEL A U 6 CONCRETE A U 10 CATHODIC PROTECTION 3 POLYVINYL CHLORIDE (PVC)A (U 4 FIBERGLASS PIPE 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ 1 MECHANICAL UNE LEAK DETECTOR 2 UNE TIGHTNESS 3 CONTINUOUS INTERSTmAL ^ 4 ELECTRONIC UNE ❑ TESTING" MONITORING LEAK DETECTOR 5 AUTOMATIC PUMP SHUTDOWN ❑ 99 OTHER V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK 2 MANUAL RECONCILIIATIONORY ❑ 3 MONIITORING VAOZE 4 GAUGING TANK ❑ 5 MONITORINGGROUND ❑ 8 TESTINGNUALTANK ❑' 7 MONITORCONTINUOUS INTERSTITIAL /❑ 8 SIR ❑ 9 WEEK LY M NUAL ❑ 10 MONTTESTIHLY TANK ❑ 95 UNKNOWN ❑ 99 OTHER VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES ❑ NO ❑ SUBSTANCE REMAINING GALLONS I INERT MATERIAL? THI FORM HAS BEEN COMPLETED UNDER PENALTY OjWERJUFY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORI TANK OWNER'S NAME I)p DATA (PRINTED b SIGNATURE) � IV.TM. "oe=_P9 LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW FCT COUNTY# JURISDICTION # FACILITY # TANK # STATE I.D:# ❑❑ �� PERMIT NUMBER I PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLI -FORMA, UNLESS A CUHHtN I FORMA MAS HttN FILtU. riigIIIIIIIIIIIiLmuzi of wmrLti tU run Hra I Auw nvno. nim rt nm SHOULD BE ACCOMPANIED BY A PLOT PJWLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE GROUND STORAGE TANK REGULATIONS FORM B (6-95)