COMPLIANCE INFO_1989-1990 - Laserfiche WebLink

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STATE OF CALIFORNI WATER RESOURCES CONTROARDO RM V: UND GROUND STORAGE TANK PROGRAM TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. MARK ONLY F-1 1 NEW PERMIT F-] 3 RENEWAL PERMIT 0 5 CHANGE OF INFORMATION D/PERMANENTLY CLOSED TANK ONE ITEM 0 2 INTERIM PERMIT F-] 4 AMENDED PERMIT El 6 TEMPORARY TANK CLOSURE g8 TANK REMOVED z FACILITY/SITE NAME WHERE TANK IS INSTALLED.4,;FfAb FARM TANK-YES❑ NO • I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY A. OWNERS TANK ID# B. MANUFACTURED BY: C. YEAR INSTALLED D. TANK CAPACITY IN GALLONS: 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),Is NOT MARKED,COMPLETE ITEM D. CTt A. ❑ 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUMB. C. ❑ 1 UNLEADED D 2 LEADED EY3 DIESEL ❑ 3 CHEMICAL PRODUCT ❑4 OIL V, PRODUCT ❑4 GASAHOL [:]5 JET FUEL 6 AVIATION GAS ❑ 5 HAZARDOUS [::]80 EMPTY ❑ 95 UN7KNOWN [::] 2 WASTE ❑7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED&C.A.S.# C.A.S.#: Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D A.TYPE OF ❑I;kUBLE WALLED F-1 3 SINGLE WALLED WITH EXTERIOR LINER F-1 95 UNKNOWN SYSTEM 2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER F-1 1 STEEL/IRON ❑2 STAINLESS STEEL F-1 3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B.TANK ❑5 CONCRETE F--j 6 POLYVINYLCHLORIDE ❑7 ALUMINUM F-1 8 100%METHANOL COMPATIBLE FRP MATERIAL [:] 9 BRONZE El 10 GALVANIZED STEEL [:] 95 UNKNOWN 0 99 OTHER C. INTERIOR F-1 1 RUBBER LINED 1:1 2 ALKYD LINING F-1 3 EPDXY LINING 0 4 PHENOLIC LINING LINING F-1 5 GLASS LINING F--]6 UNLINED 0 95 UNKNOWN [:] IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? ❑YES [::] NO ❑99 OTHER D.CORROSION F-1 I POLYETHLENE WRAP ❑ 2 TAR OR ASPHALT F-1 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [:] 5 CATHODIC PROTECTION ❑91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A.SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER A U I STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELCLADW/FRP A U 8 100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P S 1 VISUAL CHECK P S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER V1. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE K F AS TANK TE YES ❑ NO INERT MA 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN INERT MATERIAL? ❑ GALLONS THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT IAPPLICANTS NAME(PRINTED&SIGNATURE) DATE LOCAL AGENCY USE ONLY P COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# ffff] I I 1 -1 D I LLI / 1�9> lc/ lad L I [��lo I CURRENT LOCAL AGENCY FACILITY ID# APPROVED BY NAME PHONE#WITH AREA CODE COUNTY# REN Lo A U T LOCAL hvlqo PERMIT PERMIT APPROVAL DATE PERMIT EiPiRAT16NDATE CURRENT CHECK CHECK# PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT I lideL I IN&, FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIED giriAcury/siTE APPLICATION, FORM'N,UNLESS A CURRENT FORM`A' HAS BEEN FILED DATA PROCESSING COPY