COMPLIANCE INFO_1987-2001 - Laserfiche WebLink

Home Browse Search

[AUn p STATE Of CALIFORNIA .s...� �L= STATE WATER RESOURCES CONTROL BOARD i t'4 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 SITI ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ARCO Facility 5450 ® 3 FIBERGLASS 1. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF tJNKNOWN A. OWNER'S TANK I. D. # Unknown B. B. MANUFACTURED BY: UI11SIlOW1'1 C. DATE INSTALLED (MO/DAY/YEAR) 87 D. TANK CAPACITY IN GALLONS: 12,000 ILTANKCONTENTS IFA-11SMARKED. COMPLETE ITEM C. A. ® 1 MOTOR VEHICLE FUEL 4 OIL B. REGULAR C• ❑ 1aUNLEADED 3 DIESEL ❑ 6 AVIATION GAS ❑ 2 PETROLEUM 80 EMPTY ® 1 PRODUCT ® lb PREMIUM 4 GASAHOL ❑ 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. a: 111. TANK CONSTRUCTION MARK CINE ITCM f1N I V IN RnYGB An ANn n ANn AI I TUAT AOC. ICQ IAI D^V M AKI c A. TYPE OF ® 1 DOUBLE WALL a 3 SINGLE WALL WITH EXTERIOR LINER F-� 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL 4 SECONDARY CONTAINMENT (VAULTED TANK) F-� 99 OTHER B. TANK ❑ 1 BARE STEEL 2 STAINLESS STEEL ® 3 FIBERGLASS 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE F-] 6 POLYVINYL CHLORIDE F-] 7 ALUMINUM 8 100% METHANOL COMPATIBLE W/FRP (PrimaryTaok) 9 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN ❑ 99 OTHER a 1 RUBBER LINED O 2 ALKYD LINING 3 EPDXY LINING 4 PHENOLIC LINING C. INTERIOR LINING 5 GLASS LINING ® 6 UNLINED 95 UNKNOWN O 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES X NO— D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION I n; 91 NONE 95 UNKNOWN ❑ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) 95 OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) 9S IV. PIPING INFORMATION CIRCLE A IF AROVECROLJNOOR U IF I JNnF:Rr.Rr111Nn Rr1TNILAPPI Il ARI F A. SYSTEM TYPE A U 1 SUCTION AQ 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A Q 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 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 19 7 STEEL W/ COATING A U A U 95 UNKNOWN A U 4 FIBERGLASS PIPE B 1009/ METHANOL COMPATIBLE W/FRP 99 OTHER D. LEAK DETECTION X' 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3 INTERSTITIAL MONITORING ❑ 99 OTHER V. TANK LEAK DETECTION 1 VISUAL CHECK ® 2 INVENTORY RECONCILIATION F-� 3 VADOZE MONITORING a 4 AUTOMATIC TANK GAUGINGF-] 5 GROUND WATER MONITORING 0 6 TANK TESTING [:2] 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES ❑ NO ❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN CO LETED UNDERZ OF fE51ORY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME DATE (PRINTED & SIGNkTTURE) ,/ %;�/' s ,- ��%�� _ _ . `f LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE 1.D.# m PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION • FORM A. UNLESS A CURRENT FORM A HAS BEEN FILED. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (12-91) FOR00346-R6