COMPLIANCE INFO_1987-1998 - Laserfiche WebLink

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X88 0 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 F-j I NEW PERMIT ❑ 3 RENEWAL PERMIT ® 5 CHANGE OF INFORMATION F--j 7 PERMANENTLY CLOSE EL ON SITE I ONE ITEM F--j 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT E] 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED r 4 ot ocl DBA OR FACILITY NAME WHERE TANK IS INSTALLED: cp a,. I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# B. MANUFACTURED BY: C. DATE INSTALLED(MQfDAY/YEAR) Z!:om� D. TANK CAPACITY IN GALLONS: Z2z 2222 II.TANK CO NTS IF A-1 IS MARKED,OOdPLETE ITEM C. A. I MOTOR VEHICLE FUEL ❑ 4 OIL g, c. F la REGULAR UNLEADED 3 DIESEL [:] 6 AVIATION GAS 2 PETROLEUM ❑ 80 EMPTY r-Vl PRODUCT F-1 lb PREMIUM UNLEADED 4 GASAHOL ❑ 7 METHANOL F❑1 1C MOGRADE UNLEADED 5 JET FUEL ❑ 8 M85 ❑ 3 CHEMICAL PRODUCT 95 UNKNOWN E5 2 WASTE 2 LEADED 99 OTHER(DESCRIBE IN ITEM D.SELOM D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. Ill. 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 ❑ 5 INTERNAL BLADDER SYSTEM ;e9s UNKNOWN SYSTEM ❑ 2 SINGLE WALL F-1 4 SINGLE WALL IN A VAULT ❑ 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 F a l00%METHANOL COMPATIBLEWIFFIP (Pdoo"Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL E] 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ED 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING 4 PHENOLIC LINING LINING OR F-1 5 GLASS LINING 6 UNLINED 95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES— NO— D.EXTERIOR ❑ i POLYETHYLENE WRAP [:] 2 COATING 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION ❑ 5 CATHODIC PROTECTION F1 91 NONE 95 UNKNOWN ❑ 99 OTHER R SPILL CONTAINMENT INSTALLED(YEAR)— OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) I-SPILL AND OVERFILL,etc. DROP TUBE YES— NO— STRIKER PLATE YES— NO— DISPENSER CONTAINMENT YES NO IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE WF7 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH (�> UNKNOWN A U 99 OTHER C. MATERIAL AND A U I 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 =COATING A U 8 100%METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION UNKNOWN A U 99 OTHER D. [:]I MEOMCAL UNE LEAK E]2=TMMfA 3 CONTIIIUM KrERSTRAL 0 4 ffNIC UNE 5 AUTOMATIC IM 99 OTHER K DETECTION DETECTOR MONTORM DETECTOR [:] SHUTDOWN V.TANK LEAK DETECTION 1 VISUAL CHECK 2 MANUAL INVENTORY 3 VADOZE 0 4 AUTOMATIC TANK 5 GROUND WATER ANNUAL TANK F RECONCILIATION MONITORING GAUGING MONITORING TESTING MONITOR 7 CONTINUOUS INTERSTITIAL 8 SIR 09 WEEKLYGAUGING E]MANUAL ❑10 MONTHLY TANK 95 UNKNOWN 99 OTHER ING TANKTESTING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST UPED AY R) TY OF 3.WAS TANK FILLED WITH YES F-1 NO MW REMAINING INERT MATERIAL? ❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,is TRUE AND CORRECT TANK OWNERS NAME DATE (PRINTED&SIMATURE) LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# C-- STATE I.Dl 4z!� PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUWON-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. F0jKC MUST BE COMPLETED FOR INSTALLATIONS.THIS FORM SHOULD BE ACCOMPANIED BY A PLOT q9 FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THFAIIIIIIIIIiRGROUND STORAGE TANK REGULATIONS FORMS (6-95)