COMPLIANCE INFO_1990-2003 - Laserfiche WebLink

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yJu-C,. STATE OF CALIFORNIA ^�,�,••.;'`°t STATE WATER RESOURCES CONTROL BOARD r UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. `'�•�•^`' MARK ONLY Ef 1 NEW PERMIT ® 3 RENEWAL PERMIT S CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT 8 TEMPORARY TANK CLOSURE 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: S- I. TANK DESCRIPTION cMPLETE ALL ITEMS- SPECIFY IFUNKNOWN A OWNERS TANK I.D.a F B. MANUFACTURED 8Y• C. DATE INSTALLED(MO/OAYIYEAR) 1 0. TANK CAPACITY IN GALLONS: 11.TANK NTENTS IFA.tISMARKED.COMPLETE ITEM C. A. I MOTOR VEHICLE FUEL 0400- g, C. ❑ taUNLEA ED 3 DIESEL ❑ 8 AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY t PRODUCT a t REMIUM 4 GASA40L Q 7 METHANOL ❑ 3 CHEMI AL PRODUCT ❑ 95 UNKNOWN ® 2 WASTE 2 UNLEADED 0 S JET FUEL 99 OTHER (DESCRIBE IN ITEM 0. BELOW) 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.s: III. TANK CONSTRU ON MARK ONE ITEM ONLY IN BOXES A.B.AND c.AND ALL THAT APPLIES IN BOX 0 A. TYPE OF I P1 I DOUBLE WALL a 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (Y LILTED TANIQ ❑ 99 OTHER B. TANK ❑ I 8AAE STEEL ❑ 2 STAINLESS STEEL 3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE 7 ALUMINUMe 100%METHANOL COMPATIBLE W/FRP (Pr(maryTank) ❑ y BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED r72 0 LIVING ® 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING LINING s UNLINED 95 uNavowN ❑ 99 OTHER IS LINING MATERIAL COMPATIBLE WITH ICO%METHANOL? YES- NO— D.CORROSION ❑ 1 POLYETHYLENE WRAP ® 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION a 91 NONE ❑95 UNKNOWN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IFASOVE G5QUNO OR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION A N 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U I SINGLE WALL U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BASE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) U 4 F18ERGLASS PIPE CORROSION A U S ALUMINUM A U 8 CONCRETE A U 7 STEEL WICOATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHOOICPROTECTICN A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ I AUTOMATIC LINE LEAK DETECTOR ❑ 2 UNE TIGHTNESS TESTING 11N wl 99 OTHER !K NITORING ❑ V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION E) 3 VAPOR MONITORING C:] 4 AUTOMATIC TANK GAUGING® 5 GROUND WATER MONITORING ® 8 TANK TESTING 7 INTERSTI7IAl MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION I.ESTIMATED DATE LAST USED(MO/OAYIYR) 2.ESTIMATED OUANTITY OF3 WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 YES ❑ NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAME (PRINTED i SIGNATURE) DATE w s LOCAL AGENCY USE ONLY THE STATE L0.NUMBER IS COMPOSED OF FOUR NUMBERS BELOW STATE 4VFI-(�' COUNTY u JURISDICTION x FACILITY TANK x - PERMIT NUMBER PERMIT APPROVED BY/OATE PERMIT EXPIRATION DATE FOAMS (9.90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. - FOR06E49-i18 6 0 5