COMPLIANCE INFO_1986-1997 - Laserfiche WebLink

Home Browse Search

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 CLOSED ON SITE ONE REM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ri�K8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: — 1. TANK DESCRIPTION COMPLETE ALL(T EMS- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.u at.) B. MANUFACTURED BY: Q 1 kL6w d C. DATE INSTALLED(MO/DAY/YEAR) 19 e2Q D. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IF A-1 IS MARIK D.COMPLETE ITEM C. A �1 MOTOR VEHICLE FUEL El t Oil B. C. 1a REGULAR UNLEADED 3 DIESEL ❑ c AVIATION GAS ❑ 1b PREMIUM UNLEADED M 4 GASAHOL ❑ 7 METHANOL ❑ 2 PETROLEUM ❑ QO EMPTY 1 PRODUCT ❑ 1C MIDGRADE UNLEADED ❑ 5 JET FUEL ❑ 5 W5 ® 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER(DESCRZZ N r----M 0.BELOW) 0. IF(A.1)IS NOT MARKED, ENTER NAME OF SUtiTANCE STORED - C.A.S.#: 111. TANK CONSTRUCTION MARK ONS ITEM ONLY IN BOXES A.B,AND C,AND ALL THAT APPLIES IN BOX D AND I- A. 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 i BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS RE�.:CRCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE%VFRP (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 ® 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 PLt -,'-- CORROSION 91 NONE 53:95 UNKNOWN ❑ 99 OTHER PROTECTION ❑ s cATHoolc PROTECTION ❑ SPILL AND OVERFILL,6tC. SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) E DROP TUBE YES NO STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION AU 1 SINGLE WALL- A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 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 W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION 95 UNKNOWN A U 99 OTHER 1 MEOM JML UNE LEAK UNE ToffNE55 3 CONTINUOUS NTERSM& 4 M ECiRONC UNE 5 AUTOMATIC PUMP 99 OTHER D. LEAK DETECTION ❑ DMCTOR TEsrma ❑ MIOMTORING E] LEAK OMCTOR ❑ SHUTDOWN ❑ V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK 2 MANUAL I INVENTORY ❑IATION 3 MONITORING ❑ 4 GAUGG AUTOMATIC TANK ❑5 NTORINGOUND TER ❑6 TESTING ANNUALRECONCTANK ❑ 7 CONTINUOUS INTERSTITIAL ❑ 8 SIR ❑ 9 WEEKLY MANUAL ❑10 MONTHLY TANK ❑ 95 UNKNOWN ❑99 OTHER MONITORING TANK GAUGING TESTING 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? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO TH EST OF Y KNOWLEDGE,IS TRUE AND CORRECT OWNER'S NAME ` (PRII9%1 SICdU E) oc/. G8! LOCAL AGENd USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMB BELOW COUNTY M JURISDICTION k FACILITY# TANK 16 STATE I.D:# F= I :]= FT-7-1IIZJ PERMIT NUMBER PERMIT APPROVED BY/OATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS.THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (695)