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BILLING_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0232385
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BILLING_PRE 2019
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Entry Properties
Last modified
7/1/2021 11:49:58 AM
Creation date
11/5/2018 1:39:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0232385
PE
2381
FACILITY_ID
FA0003531
FACILITY_NAME
BEST CLEANERS
STREET_NUMBER
541
Direction
N
STREET_NAME
HUTCHINS
STREET_TYPE
ST
City
LODI
Zip
95240
APN
03725001
CURRENT_STATUS
02
SITE_LOCATION
541 N HUTCHINS ST
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\H\HUTCHINS\541\PR0232385\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
5/28/2013 8:00:00 AM
QuestysRecordID
169356
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD i <br /> FORM B': UNDERGROUND STORAGE TANK PROGRAM <br /> TANKTANK PERMIT APPLICATION INFORMATION <br /> z <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. <br /> 10 <br /> MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWALPERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOS <br /> ED TANK <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE [6eANK REMOVED /0 F/ <br /> 5 CA) <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: FARM TANK-YES❑ NO W <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY <br /> A. OWNERS TANK]DO B. MANUFACTURED BY: <br /> C. YEAR INSTALLED D. TANK CAPACITY IN GALLONS: O <br /> II. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. ❑ 1 MOTOR VEHICLE FUEL ❑2 ROLEUM B. C. ❑ 1 UNLEADED ❑ 2 LEADED ❑ 3 DIESEL <br /> ❑3 CHEMICAL PRODUCT ❑ 4 OIL ❑ 1 PRODUCT ❑4 GASAHOL ❑ 5 JET FUEL ❑ 6 AVIATION GAS <br /> ❑ 5 HAZARDOUS ❑ 80 EMPTY 95 UNKNOWN ❑ 2 WASTE ❑ 7 METHANOL ❑99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME O <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.# C.A.S.#: <br /> III. TANK CONSTRUCTION MARK ONE ITE NLY IN BOXA,B,C,&D <br /> A.TYPE OF ❑ 1 DOUBLE WALLED AMETHANOL? <br /> LE WA ED WITH EXTERIOR LINER ❑95 UNKNOWN <br /> SYSTEM ❑2 SINGLE WALLED NDARY AINMENT ❑99 OTHER <br /> ❑1 STEEL/IRON INlES6 STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD WIFIBERGUSS REINFORCED PLASTIC <br /> B. TANK ❑5 CONCRETE POLYVINYL CHLORIDE 7 ALUMINUM ❑6100%METHANOL COMPATIBLE FRP <br /> MATERIAL <br /> ❑9 BRONZE LVANIZEDSTEEL 95 UNKNOWN ❑ 99 OTHER <br /> ❑ 1 RUBBER UNED YD LINING ❑ EPDXY LINING ❑4 PHENOLIC LINING <br /> C. INTERIOR 5 GLASS LININGINED ❑ 96 UNKNOWN <br /> LINING ❑ <br /> ❑ IS LINING MATERIAL COM %METHANOL? ❑YES NO ❑ 99 OTHER <br /> D. CORROSION ❑ 1 POLYETHLENE WRAP ❑ 2TAR OR ASPHALT ❑3 VIWLW ❑4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION E] 5 CATHODIC PROTECTION F] 91 NONE [-]95 UNKNOWN ❑99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUN BOTH IF APPLICABLE <br /> A.SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVIA A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TR CH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL HLORIDE(PVC) A U 4 FISERGLASSPIPE A U 91 NONE <br /> C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD VP A U B 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZEDSTEEL A U 95 UNKNOWN A U 99 OTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIM RY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> P S 1 VISUALCHECK P 8 2 INVENTORY RECONCIUATION P S 3 VADOSE WELLS P 8 4 ELECTRONI MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH <br /> SUBSTANCE REMAINING IN <br /> GALLONS INERT MATERIAL? ❑YES [:] NO <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED 8 SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# <br /> ml = = I lola1 ,31vl;51o0 <br /> CURRENT CA=AGENCY FACT ITY ID# APPROVED BY NAME .�f� PHONE#WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PER IT EXPIRATION DATE <br /> CHECK# PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT# BY: <br /> FORMB(6-29-BB) THIS FORM MUST BE ACCOMPANQ, FACILITYISITEAPPLICATION, FORM `A',UNLESS ENT FORMA' HASBEENFILED <br /> I DATA PROCESSING COPY <br />
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