COMPLIANCE INFO_1993-2002 - Laserfiche WebLink

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• • SOURCES STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD 3 , % UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY OSE E ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE 8 TANK REMOVE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ANASTAS I OAM M MINI A I. TANK DESCRIPTION COMPLETE ALL ITEMS-- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# UNKNOWN B. MANUFACTURED BY: UNKNOWN C. DATE INSTALLED(MO/DAY/YEAR) June 1972 D. TANK CAPACITY IN GALLONS: 8000 II.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. A ® 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C• © la REGULAR ❑ 3 DIESEL ❑ 6 AVIATION GAS F-] 2 PETROLEUM 80 EMPTY ® 1 PRODUCT ❑ lb PREMIUM ❑ 4 GASAHOL -� 7 METHANOL UNLEADED ❑ 5 JETFUEL �1 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN 2 WASTE a 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 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 (VAULTEDTANK) ❑ 99 OTHER © B. TANK 1 BARE STEEL F-] 2 STAINLESS STEEL F-] 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE F-� 7 ALUMINUM a 8 100°/ METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL O 95 UNKNOWN ❑ 99 OTHER F--] 1 RUBBER LINED F-] 2 ALKYD LINING F7 3 EPDXY LINING F-] 4 PHENOLIC LINING C.INTERIOR LINING F-] 5 GLASS LINING 7 6 UNLINED F7 95 UNKNOWN 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO— D.CORROSION ❑ i POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ®95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) UNKNOWN OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) UNKNOWN IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION AM 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION AQ1 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 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A[j]95 UNKNOWN A U 99 OTHER D. LEAK DETECTION KX 1 AUTOMATIC LINE LEAK DETECTOR XX 2 LINE TIGHTNESS TESTING ❑ 3 M RSI A MONITORING 1:199 OTHER V.TANK LEAK DETECTION F❑ 1 VISUAL CHECK ® 2 INVENTORY RECONCILIATION [:] 3 VADOZE MONITORING a 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING © 6 TANK TESTING F-17 INTERSTITIAL MONITORING E] 91 NONE 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES ❑ NO ❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME DATE (PRINTED 8 SIGNATURE) b V4 E eZT S •3 93 LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW (�5 - rt COUNTY# JURISDICTION# FACILITY# TANK# STATE I.DA FT-Fl 1 0 ��-93 ol 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. 0 FOR00046-RS