COMPLIANCE INFO_1991-1994 - Laserfiche WebLink

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66°ua es STATE OF CALIFORNIA Ae P cO� STATE WATER RESOURCES CONTROL BOARD F 4a o UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B a .; . o COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM MARK ONLY NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITI ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: f }4ELj-- 6%--ovicr=- OCj� 1. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# �.INtr-1�tVl�1-I B.C B. MANUFACTURED BY: uMlwopoo C. DATE INSTALLED (MO/DAY/YEAR) ) v D. TANK CAPACITY IN GALLONS: �J c>r->® 11.TANKCONTENTS IFA -1 IS MARKED. COMPLETE ITEM C. A1 MOTOR VEHICLE FUEL ❑ 4 OIL B.C UrgGULAR UNLEADED 3 DIESEL 6 AVIATION GAS ❑ 4 GASAHOL ❑ 2 PETROLEUM ❑ 80 EMPTY 1 PRODUCT ❑ lb PREMIUM 7 METHANOL ❑ UNLEADED ❑ 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 APPLIES IN BOX D A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER95 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 ❑ 6 POLYVINYL CHLORIDE ❑INUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE 10 GALVANIZED STEEL ��96 UNKNOWN ❑ 99 OTHER A U 10 CATHODIC PROTECTION ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR ❑ 5 GLASS LINING ❑ 6 UNLINED ©�9.5 UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 33 VINYL WRAP E]4 FIBERGLASS REINFORCED PLASTIC PROTECTION [:]5 CATHODIC PROTECTION F--]91 NONE �95 UNKNOWN ❑ 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IFAPPLICARI_9 A. SYSTEM TYPE A U 1 SUCTION A&1 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A lid 2 DOUBLE WALL A U 3 LINED TRENCH A4095 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(D95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [::] 1 AUTOMATIC LINE LEAK DETECTOR Ej 2 LINE TIGHTNESS TESTING ❑ 3 MONITORING 99 ERSTITIAL OTHER Uoe,�.• Ilw,J V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING ❑ 44 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITOR INC ❑ 6 TANK TESTING [:j7 INTERSTITIAL MONITORING ❑ 91 NONE E-95 UNKNOWN ❑ 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED OUANTITY OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING JW GALLONS INERT MATERIAL? YES NO ❑ r THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCA APPLICANTS NAME {� p (PRINTED& SIGNATUREA, �...f �� qC�� DATE )YC AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF E FOUR NUMBERS BELOW 1 COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# m HERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR00346-R4