COMPLIANCE INFO_1987-2001 - Laserfiche WebLink

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S�uRCfS STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD s " UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B` a COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 0 1 NEW PERMIT 0 3 RENEWAL PERMIT �5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED,--,- DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Al2r p FAL �,JQ , 5L4,S-1&19k1l I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # 2 - V B. MANUFACTURED BY: W E ►�lS Cp2t�l t r.lCa C. DATE INSTALLED(MO/DAY/YEAR) l� . !S7 D. TANK CAPACITY IN GALLONS: 1Z OoO II. TANK CONTENTS IFA -1 IS MARKED. COMPLETE ITEM C. A 1 MOTOR VEHICLE FUEL 4 OIL ❑ B. REGULAR ❑ 3 DIESEL C �a UNLEADED 116 AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY I?" ' PRODUCT ❑ 4 GASAHOL ❑ 1b ❑ 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 ROXES A. R. AND C. AND ALI THAT APPI IFS IN Rnx In ANn F 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 F—]1 BARE STEEL F--]2 STAINLESS STEEL Q--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 ❑ 99 OTHER 5 ALUMINUM ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR ❑ 5 GLASS LINING UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER LINING A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ 1 IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO INIERSTITIAL D. CORROSION ❑ 1 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) 19g'� OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) IV. PIPING INFORMATION CIRCLE A IFABOVE GROUND OR U IF UNDERGROUND- ROTH IFAPPI ICARI F A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL Aa)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 0 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 ❑ 2 LINE TIGHTNESS TESTING INIERSTITIAL 0 gg OTHER MONITORING V. TANK LEAK DETECTION LE❑ 1 VISUAL CHECK F--]2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING F—]4 AUTOMATIC TANK GAUGING F--]5 GROUND WATER MONITORING 6 TANK TESTING ��INTERSTITIALMONITORING E:]91 NONE ❑ 95 UNKNOWN F—]99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONSINERT MATERIAL ? YES E:] NO ❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME DATE (PRINTED d SIGNATURE) s a fes► LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMB RS BELOW STATE I. D.# COUNTY # JURISDICTION # FACILITY # TANK # 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 BEE FILED. i FOR0036-1115