COMPLIANCE INFO_1986-1997 - Laserfiche WebLink

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- STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD y UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY LJ t NEW PERMIT El 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON SITE ONE ITEM 2 INTERIM PERMIT a 4 AMENDED PERMIT El 6 TEMPORARY TANK CLOSURE Q 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: P-61--'I*r ICS 5l cc-c-G-Tzc I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.# 110%. I B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAYNEAR) :tl L cl I D. TANK CAPACITY IN GALLONS: i'30��0 II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. l A. �1 MOTOR VEHICLE FUEL a 4 OIL B. C. U la REGULAR UNLEADED 3 DIESEL 6 AVIATION GAS a 2 PETROLEUM a 80 EMPTY .1 PRODUCT TO PREMIUM UNLEADED 0 4 GASAHOL 7 METHANOL (-�'� tc MIDGRADE UInEADED 05 JET FUEL � 8 M85 O 3 CHEMICAL PRODUCT 95 UNKNOWN I L J 2 WASTE I ❑ 2 LEADED 0 99 OTHER(DESCRIBE IN ITEM 0.BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.N: 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 Z 1 DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER FD INTERNAL BLADDER SYSTEM 0 95 UNKNOWN SYSTEM 2 SINGLE WALL 4 SINGLE WALL IN A VAULT- 99 OTHER B. TANK El 1 BARE STEEL a 2 STAINLESS STEEL 3 FIBERGLASS ( _4 STEEL CLAD Vel FIBERGLASS REINFORCED PLASTIC MATERIAL F--j 5 CONCRETE a 6 POLYVINYL CHLORIDE n 7 ALUMINUM 8 100% METHANOL COMPATIBLE WIFRP (Primary Tank) 0 9 BRONZE 10 GALVANIZED STEEL L, 95 UNKNOWN 99 OTHER C.INTERIOR 1 RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING 4 PHENOLIC LINING LINING OR 5 GLASS LINING 5kt UNLINED 95 UNKNOWN 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES--- NO___ D.EXTERIOR M 1 POLYETHYLENE WRAP O 2 COATING F-1 3 VINYL WRAP 5;a� FIBERGLASS REINFORCED PLASTIC CORROSION 5 CATHODIC PROTECTION NE 95 UNKNOWN PROTECTION � L� 91 NO �__-�___ F-1 99 OTHER E.SPILL AND OVERFILL,EIC. SPILL CONTAINMENT I STALLED(YEAR)—t�� OVERFILL P VENTION LOl11PMENT INSTALLED(YEAR)-Y 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 CU> SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A(�U�> DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U i 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 C MPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN AID 99 OTHER 14DEE D. LEAK DETECTION Q 1 MECHANICAL LINE LEAK f 1 2 LINE IIGN1NE55 1� YJ CONTINUOUS iN1ER511TIAI "7 A EEECI{IONIC LINE a S AUTOMATIC PUMP �y99 OTHER ll--'S f--%5C-n' DETECTOR 0 IE5/1NG �'q• MCMTORING J IEAK DETECTOn SaUTDOWN l2'�ti- V.TANK LEAK DETECTION a 1 VISUAL CHECK 2 MANUALRECONCNVENTORY 3 MIATION ONOITORING ZE 4 GAUD NGAUTOMATIC TANK 5 MON TORINGGROUND TER 6 TESTINGANNUAL TANK Z7 CONTINUOUS INTERSTITIAL O 8 SIR O 9 WEEKLY MANUAL El 10 MONTHLY TANK a 95 UNKNOWN 99 OTHER MONITORING TANK GAUGING TESTING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST USED(MO/DAY/YR) _ I 2.ESTIMATED QUANTITY OF _-. I 3.WAS TANK FILLED WITH YES [-] NO Q SUBSTANCE REMAINING GALLONS INERT MATERIAL 4 THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND HE BE T OF MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNER'S NAME DATE (P TED d SIGNATURES _ t j c LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR IMSERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.# �D J LLJ ❑= Flm PERMIT NUMBER Ir PERMIT APPROVED BY/DAIS T 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 FORMS (6-95)