COMPLIANCE INFO_1987-1995 - Laserfiche WebLink

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s��R�Fs STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B <� COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT F__] RENEWAL PERMIT F75 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT Iy l 4 AMENDED PERMIT'* ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Q/t�rj '�`e2/3 3 o I. TANK DESCRIPTION COMPLETE ALL ITEMS-- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# B. MANUFACTURED BY: �^ C. DATE INSTALLED(MO/DAY/YEAR) 9 / D. TANK CAPACITY IN GALLONS: J O II.TANK CONTENTS IFA-1 IS MARKED,COM5IeETEITEMC. A ❑ 1 MOTOR VEHICLE FUEL Evr4 OIL B. C. ❑ laREGULAR ❑ 3 DIESEL ❑ 6 AVIATION GAS UNLEA ❑ 4 GASAHOL ❑ 2 PETROLEUM ❑ 80 EMPTY ❑ 1 PRODUCT ❑ lbUNLEADED E] JET FUEL ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN I ` WASTE ❑ 2 LEADED gg OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED O —�j/A(,1� C.A.S.#: _ III. TANK CONSTRU N MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ D LINING F—] 3 EPDXY LINING F—] 4 PHENOLIC LINING C.INTERIOR F—] 5 GLASS LINING 6 UNLINED ❑ 95 NOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION CATHODIC PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLE A IFABOVE G NDO `U IFUNDERGROUND,BO BLE A. SYSTEM TYPE A U 1 SUCTION A U ESSURE A3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A UB WALL A U 3 LI D TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U,FIBERGLASS PIPE CORROSION A U 5 AL INUM p 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIB E W/FRP PROTECTION A U GALVANIZED STEEL— U C HO C N A U 95 UNKNOWN A U 99 OTHE D. LEAK DETECTION AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3 MONITORING 99 OTH \ V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 ;�WATERNITORING❑ 6 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE 95 UNKNOWN 99 O VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES NO❑ I SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FOR AS BEEN COMPLETED UNDER PENH F PERJ AND TO THE BE OF MY KNOWLEDGE, IS TRUE AND CORRECT A C T'S NAM DATE T T E _2f�/ LOCAL AGEN USE ONLYffG//iTTH SSTTAfT,E I.D.NUMBER Al -- MPO D OF THE FOUR NUMBERS BELOW QC (o COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.# 2f�k PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. iFOR0034B-R5 *lj •