COMPLIANCE INFO_1991-1994 - Laserfiche WebLink

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• ' • � a % � GspU-CES STATE OF CALIFORNIA r �° STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B p�clFon N`� COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT �K_5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITFMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # B. �1 PRODUCT 2 WASTE C 1a REGULAR ❑ 3 DIESEL ❑ UNLEADED 4 GASAHOL 6 AVIATION GAS t❑I 1b PREMIUM ❑ ❑ 7 METHANOL UNLEADED ❑ 5 JET FUEL ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) B. MANUFACTURED BY: SYSTEM C. DATE INSTALLED (MO/DAY/YEAR) 1964 ❑ 99 OTHER D. TANK CAPACITY IN GALLONS: 5,000 II. TANK CONTENTS IFA-11SMARKPICOMPIFTFITFMC VOI?MTTTA CUPTT ATTTC A. 1 MOTOR VEHICLE FUEL ❑ 4 OIL 2 PETROLEUM ❑ 80 EMPTY ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN B. �1 PRODUCT 2 WASTE C 1a REGULAR ❑ 3 DIESEL ❑ UNLEADED 4 GASAHOL 6 AVIATION GAS t❑I 1b PREMIUM ❑ ❑ 7 METHANOL UNLEADED ❑ 5 JET FUEL ❑ 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 MACK rINC ITEM rlNll V INI Rr1YCC A a AAIM c AKIn Al I TUAT A... — --n —11 A. TYPE OF F--1 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 F—]2 STAINLESS STEEL F—]3 FIBERGLASS ❑ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL 5 CONCRETE 0 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 1009/ METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER 5 ALUMINUM F—]1 RUBBER LINED F--12 ALKYD LINING ❑ 3 EPDXY LINING F--]4 PHENOLIC LINING C. INTERIOR LINING F-]5 GLASS LINING [:]6 UNLINED S495 UNKNOWN ❑ 99 OTHER A U IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES _ NO 1 D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE I7�a/i UNKNOWN ❑ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 094 1 SUCTION A02 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTIONU 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A 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 1009/6 METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR 5C 2 LINE TIGHTNESS TESTING ❑ 3 INTERSTITIAL MrtNrrnawr. n 99 OTHER V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING L❑ 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 E]NO ❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN D U ENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICAN2�! E DATE (PRINTED & EI 9/12/94 LOCAL AGENCY USE LY THE STVf I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I. D.# m II ❑❑-1 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. FOR0064B-RS