Laserfiche WebLink
s o.f, <br />STATE OF CALIFORNIA ` "' <br />STATE WATER RESOURCES CONTROL BOARD <br />UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B <br />0 <br />COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br />MARK ONLY F-] 1 NEW PERMIT Q <br />3 RENEWAL PERMIT <br />® 5 CHANGE OF INFORMATION <br />0 7 PERMANENTLY CLOSED ON SIT <br />ONE ITEM a 2 INTERIM PERMIT F-] <br />4 AMENDED PERMIT <br />F-� 6 TEMPORARY TANK CLOSURE <br />0 8 TANK REMOVED <br />DBA OR FACILITY NAME WHERE TANK IS INSTALLED: <br />ARCO Facility <br />5450 <br />® 3 FIBERGLASS <br />1. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN <br />A. OWNER'S TANK 1. D. * UnlinOWl'1 <br />B. MANUFACTURED BY: Unknown <br />C. DATE INSTALLED (MO/DAY/YEAR) 87 <br />D. TANK CAPACITY IN GALLONS: 1 2 OOO <br />ILTANKCONTENTS IFA -t ISMARKFn COMP) FTFITFMC Aft, A —1— <br />A. ® i MOTOR VEHICLE FUEL 4 OIL <br />g <br />C F a 3 DIESEL 6 AVIATIONGAS <br />UNLEADED <br />2 PETROLEUM � 80 EMPTY <br />® 1 PRODUCT <br />O 4 GASAHOL <br />1bPREMIIUM 5 JET FUEL � 7 METHANOL <br />3 CHEMICAL PRODUCT O 95 UNKNOWN <br />E] 2 WASTE <br />Q 2 LEADED 99 OTHER (DESCRIBE IN ITEM D. BELOW) <br />D. IF (A-1) IS NOTMARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. # : <br />til. TANK CONSTRUCTION MARK nNF ITFM ANI Y IN RnXFR A R ANn C ANn At 1 TWAT APP) Irc IaI PnV n Aero c <br />A. TYPE OF <br />F -X 1 DOUBLE WALL <br />3 SINGLE WALL WITH EXTERIOR LINER <br />a 95 UNKNOWN <br />SYSTEM <br />2 SINGLE WALL <br />Q 4 SECONDARY CONTAINMENT (VAULTED TANK) <br />Q 99 OTHER <br />B. TANK <br />1 BARE STEEL <br />2 STAINLESS STEEL <br />® 3 FIBERGLASS <br />F-� 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC <br />MATERIAL <br />5 CONCRETE <br />F-] 6 POLYVINYL CHLORIDE <br />a 7 ALUMINUM <br />8 100% METHANOL COMPATIBLE W/FRP <br />(Primary Tank) <br />9 BRONZE <br />10 GALVANIZED STEEL <br />E:j 95 UNKNOWN <br />99 OTHER <br />7 STEEL W/COATING A U 8 100°/ METHANOL COMPATIBLE W/FRP <br />a 1 RUBBER LINED <br />2 ALKYD LINING <br />3 EPDXY LINING <br />O 4 PHENOLIC LINING <br />C. INTERIOR <br />LINING <br />O 5 GLASS LINING <br />® 6 UNLINED <br />95 UNKNOWN <br />E� 99 OTHER <br />DETECTOR [:]2 LINE TIGHTNESS TESTING ❑ 3 INTERSTITIAL <br />❑ 99 OTHER <br />IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? <br />YES i_ NO— <br />D. CORROSION <br />1 POLYETHYLENE WRAP <br />F-] 2 COATING <br />F--] 3 VINYL WRAP <br />❑ 4 FIBERGLASS REINFORCED PLASTIC <br />PROTECTION <br />5 CATHODIC PROTECTION ® 91 NONE <br />95 UNKNOWN <br />a 99 OTHER <br />E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) 95 <br />OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) 95 <br />IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF LINDFRGRnl ]Nn ROTI -1 IF APPI ICARI C <br />A. SYSTEM TYPE <br />A U <br />1 SUCTION <br />AD <br />2 PRESSURE A U <br />3 GRAVITY A U 99 OTHER <br />B. CONSTRUCTION <br />A U <br />1 SINGLE WALL <br />A <br />2 DOUBLE WALL A U <br />3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br />C. MATERIAL AND <br />A U <br />1 BARE STEEL <br />A U <br />2 STAINLESS STEEL A U <br />3 POLYVINYL CHLORIDE (PVC) A 4 FIBERGLASS PIPE <br />CORROSION <br />A U <br />5 ALUMINUM <br />A U <br />6 CONCRETE A U <br />7 STEEL W/COATING A U 8 100°/ METHANOL COMPATIBLE W/FRP <br />PROTECTION <br />A U <br />9 GALVANIZED STEEL <br />A U <br />10 CATHODIC PROTECTION <br />A U 95 UNKNOWN A U 99 OTHER <br />D. LEAK DETECTION <br />EX <br />1 AUTOMATIC LINE LEAK <br />DETECTOR [:]2 LINE TIGHTNESS TESTING ❑ 3 INTERSTITIAL <br />❑ 99 OTHER <br />MONITORING <br />V. TANK LEAK DETECTION <br />1 VISUAL CHECK ® 2 INVENTORY RECONCILIATION a 3 VADOZE MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITOR INC <br />6 TANK TESTING D 7 INTERSTITIAL MONITORING F --j 91 NONE D 95 UNKNOWN [:] 99 OTHER <br />VI. TANK CLOSURE INFORMATION <br />1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES NO <br />SUBSTANCE REMAINING GALLONS INERT MATERIAL? <br />THIS FORM HAS BEEN C PLETED UNDER P OF PERJ RY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br />APPLICANTS NA��i� <br />(PRINTED A SIGNATU/(�/"/, DATE <br />LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW <br />COUNTY # JURISDICTION # FACILITY # TANK # <br />STATE I.D.# m = III illim <br />PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE <br />THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION . FORM A. UNLESS A CURRFNT FORM A HAS RFFN Fu Fn <br />FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS <br />FORM B (12-91) <br />FOR00346-R6 <br />