COMPLIANCE INFO_1987-2001 - Laserfiche WebLink

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• STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A S `°.•�: EPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT =,'�--15 CHANGE CF INFO MATI �.� PERMANENTLY CLOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPT URE 1 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. x_ l..i �� _ 8. MANUFACTURED BY: O��S _ C.C> f2� 1 �� C. DATE INSTALLED (MO/DAYNEAR) to L / E 7 D. TANK CAPACITY IN GALLONS: IZ 10 C> b II. TANK CONTENTS [PA.1ICMAPI(CrinnuclCTCITCrAr q,✓1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C. UNLEADED 3 DIESEL u 6 AVIATION GAS 1 2 PETROLEUM 80 EMPTY ❑ 1 PRODUCT C� � I � 15. RE.MIUM 4 GASAHOL 7 METHANOL 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE UNLEADED ❑ 5 JET FUEL L-1_ —1I 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM 0. BELOW) D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C. A. S. x : III- T ONK C nNSTRI ICTICIN \AA V /1AIG TBAI w v w nnv n • _..._ .__. __ _ _ _ A. TYPE OF ❑✓ 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 ❑ 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 El 99 OTHER 6 CONCRETE A U 10 CATHODIC PROTECTION 1 RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR ❑ 5 GLASS LINING ❑II 6 UNLINED 95 UNKNOWN ❑ 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO_ D. CORROSION ❑ 1 PDLYETHYLENE 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) -L915:7-OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) IV, r)rli'gU II41-UNIVIA1IUN CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND. BOTH IFAPPLICARLF A. SYSTEM TYPE A U 1 SUCTION A (D2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL 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)AU 4 FIBERGLASS PIPE CORROSION PROTECTION A U A U 5 ALUMINUM 9 GALVANIZED STEEL A U A U 6 CONCRETE A U 10 CATHODIC PROTECTION 7 STEEL W/ COATING A U A U 95 UNKNOWN A U 8 100% METHANOL COMPATIBLE W,FRP 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑I I I A MONITORING ❑ 99 OTHER . I ANK LtAK Ut I I_G I IUN I VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUNDWATER MONITORING 6 TANK TESTING 7 INTERSTITIAL MONITORING 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER Vi. TANK CLOSURE INFORMATION t. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS I INERT MATERIAL ? YES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME (PRINTED d SIGNATURE) DATE LOCAL AGENCY USE ONLY THE STATIC I n Ni IMRFR IS (Y1MPr1CCn OC TUC CAI ID \I 11.110 OCI nul I - STATE I.D.# ��' l (�, COUNTY # � JURISDICTION # � FACILITY # TANK # I Z � � I' �+�- SER"AIT NUMBc'RPERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE FCR!,I 3 (7-91) 1 HIS FDHM MUST BE ACCOMPANIED BY A PERMIT APPLICATION • FORM A, UNLESS A CURRENT FORM A HA-6EEN FILED, F0R0W4 B -R5