COMPLIANCE INFO_1986-1997 - Laserfiche WebLink

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Official Registration Form qI ., CaliforniaWater Resources Control BoardHazardous Substance Storage Statement Who Must File:Each person stonno hazardous substances in any unaer- the tank Wastes are included ground container must tyle this form no later than July t.1984(After October Fee: For each lank registered a$10 lee must tie paid except that retail t 1984 and no tater than January 1 1985 for tanks used on farms) gasoline stations pay$5 per tank DeeMllon of Underground Containers: The law applies 10 concrete penalties:For failure tc file the pcnatly IS S500•f5000 per day It you faisity sumps nonvauneo buried tanks or other underground containers (water information you can be fined up to 520000 to each day the information is Code section 13173)All containers including earthen walled pits.ponds incorrect and has not been corrected lagoons and sumps mat are below the normal ground surface levet must register A tank sitting on the ground is nor included Containers partially Corse allacfly: II you nave rMorn on t strmtprotected by trade secret taws beneath the surface are included Lined or unlined pits ponos and lagoons Wease auacn a list of the tmormafron on this tom roar a confidential dna the are covered it earth has been removed from the storage area to corstruct justification for ronndemanfy including specific citations of relevant statu tory and case law tee facility Normal grading isnot considered construction below ground Multiple Containers:Fill I and II on one form and leave a blank lin an me level remaining forms Attach ail forms together securely ti you own mote than of the ab of doe or in Substance.25 1 Any substance osteo in Section 6382 50 tanks you can file information on computer tape Can 916/324 1262 to of the Labor Code or.n Section 25316 of the Hearin and Safety Cone This information includes gasoline diesel fuel all noustf al solvents pesticides herbiCideS and fumigants If fire material must be carried by a regtsteretl hauler.Ills This is not a Permit Application.All Underground Tanks win be subien to posed of at a hazardous wasle site is explosive generates pressure due to local regulation Some jurisd:clions nave already begun programs Check heat or decomposition or would harm.humans or midlife you must register win your local county government to further information NOTE.ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FORCE. I Owner Marne 11, W.-iriavauX o PA Ag,—Y, Pacific Be], sreXAmeu 26OD Camino Rgmon r Room 2.EO60 e"'San kr enorl 9X` "P94583 II Facility tatter tame �. Sc1vA9 e Pa -040 n air—AOa SS NCXlY Crafa Saee� Rtl L..�NCot`tl Zi 0Ea0 PaciFic r�venct� .".Ay .�.auMY ICY S't O�KTa N JAt t3oE nMt,s4 11 S XO'11 MawtS>mess 44 W65't Yokttts Str-eel cox S Sm IP tockton 9S207 -19" Tee (2-09) ti-74 -4377 =.-.--.—,oiVehiCle _ Fuel Station Qdo:Other _ aavmoer a ran.s a�inn PuwY Rural Aeess tc.rrnn.o n+nQe sedan l Only: III 24 Hour Emergency Contact Person don+kame rav•wine-,am Phone a area cone 4 t 5• Q 2 3 - "17 7 7 mv.,,,tame wsi name i"dna fit...a•<a coot r l 15 F 2 3 -7-7 7 7 Emergency ntrCenter COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Descripbon roiiWrrr nums.r to nr,c.s nc�,.ta..ass r+�. A IL,Tank O m Sump ❑03 Lagoon.Pit or Pond O a Other 'D—�0_S S c S. Manufacturer(if appropriate) Unknown Year of Mtg. Year Installed: IllI O ❑Unknown D Contain—Capacity_%E= gallons O Unknown E. Container Repairs ❑of None 6f o2 Unknown 0 03 Yes Year F Is Container currently usedl lil4-Yes O o2 No 8 No,year of last use O a3 Unknown G Does the Container Store(Check One) ❑o,Waste Pio:Product H Does the Container Store Motor Vehicle Fuel or Waste DO Is a,Yes 0 c No It Yes Check appropriate box(es) ❑of Unleaded 0 w Regular O 03 Premium 1111 a Diesel O its ta'aste Oil O o6 Other(List) V Container Construction A Thickness of Primary Containment: O Gauge ❑Inches 0 cm @ Unknown B O w Vaulted(Located in an underground Vault) N c2 Non-vaulted O w Unknown C ❑or Double Walled a o:Single Waited O w Lined O-Wrapped ❑of,None D )C:,Carbon Steel ❑o2 Stainless Steel ❑o3 Fiberglass O ora Polyvinyl Chloride O as Concrete ❑m Aluminum O o-Steel Clad O u Bronze O ora Composite Oto Non-metallic ❑ it Earthen Walls 12 Unknown ❑13 Other E ❑0,Rubber Lined O o2 Alkyd Lining ❑03 Epoxy Lining O a Phenolic Lining O 0s Glass Lining O o6 Clay Lining ew Unlined 111vit4gloilinewn Cog Other F ❑:+Polyeintene Wrap Or Vinyl Wrapping Cc)Cathodic Protection w Unknown 44 Alamoer6tR -2tsASiRt