COMPLIANCE INFO_1986-2004 - Laserfiche WebLink

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■ A. OWNER'S TANK 1. D. #of STATE OF CALIFORNIA • C to REGULAR ❑ 3 DIESEL ❑ 6 AVIATION GAS UNLEADED 6°U�F3 � P� 1 PRODUCT STATE WATER RESOURCES CONTROL BOARD 6 3 D. TANK CAPACITY IN GALLONS: D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. # UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B w �� 0 . tti > ❑ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ❑ 5 CONCRETE C4(IP tJN N.r MARK ONLY 1 NEW PERMIT F—]_>IRENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY ClITE ONE ITEM ❑ 2 INTERIM PERMIT I AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED O DBA OR FACILITY NAME WHERE TANK IS INSTALLED: r— T I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN ❑ 4 PHENOLIC LINING C. INTERIOR LINING A. OWNER'S TANK 1. D. #of g, C to REGULAR ❑ 3 DIESEL ❑ 6 AVIATION GAS UNLEADED B. MANUFACTURED BY: 1 PRODUCT C. DATE INSTALLED (MO/DAYNEAR) 6 �� D. TANK CAPACITY IN GALLONS: D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. # II -TANK CONTENTS IFA -t I.SMARKF:DCOMPIETFITF:MC. / A 1 MOTOR VEHICLE FUEL ❑ 4 OIL g, C to REGULAR ❑ 3 DIESEL ❑ 6 AVIATION GAS UNLEADED ❑ 2 PETROLEUM ❑ 80 EMPTY 1 PRODUCT ❑ 4 GASAHOL ❑ lbUN EAPREMIUM7 METHANOL ❑ 5 JET FUEL ❑ ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. # III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPI IFS IN Rnx n ANn F A. TYPE OF F—] DOUBLE WALL F—]3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (V TEDTANK) ❑ 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 6 CONCRETE A U ❑ 1 RUBBER LINEDALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR LINING F—]5 GLASS LINING 6 UNLINED ❑ 95 U NOWN ❑ 99 OTHER --- D. LEAK DETECTION IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO_ DETECTOR 2 LINE TIGHTNESS TESTING ❑ 3 TERSTITIAL MONITORING D. CORROSION�-5CATHODIC 1 LYETHYLENE WRAP F—]2 COATING F--]3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION PROTECTION ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) I%7s�-- OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) IV. PIPING INFORMATION CIRCLE A IFA13OVE GROUND OR U IF UNDERGROUND. BOTH IF APPI ICARI F A. SYSTEM TYPE A U 1 SUCTION p KZ5ESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION Ag SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED 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 4 FIBERGLASS PIPE CORROSION A U ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U ;/GALVANIZED STEEL U 10 CATHODIC OTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING ❑ 3 TERSTITIAL MONITORING ❑ 99 OTHER V. TANK LEAK DETECTION ❑ 1,xi UAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING 5G UND WATER MONITORIN 6 T TESTIN ,C�❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN 9 OTHER , VI. TANK CLOSURE INFORMATIO 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 3. WAS TANK FILLED WITH YES ❑ NO ❑� GALLONS INERT MATERIAL? THIS FO AS BEEN COMPLETED UNDER P LTY (3F PERJU Y, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT NTS NA / a GNA RE DATE LOCAL AGENC USE ONLY THE STATE I.D. NUM IS C MPOSED OF THE FOUR NUMBERS BELOW �v / COUNTY # JURISDICTION # FACILITY # TANK it STATE I.D.# PERMITNUMBER PERMIT APPROY Y/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. FOR0034&RS I s"