COMPLIANCE INFO_1994-2001 - Laserfiche WebLink

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0 STATE 0FCAUFonNIA UNDERGROUND STATE WATER R ATE R SOURCES CONTROL BOARD STORAGE TANK PERMIT App w P • Cwt LIGATION-FORM B MARK ONLY COMPLETE A SEPARATE FO ` ONE ITEM ❑ t NEW PERMIT RM FOR EACH TANK SYSTEM• ❑ 2 INTERIM PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION DBA OR FACILITY NAIVE yy 4 AMENDED PERMIT (�—� HERE TANK IS INSTALLED: `--' 6 �MPORARY TANK CLOSURE ❑ ? pERMANENTLY CLO I• TANK DESCRIPTION ' ❑ 6 TANK REMOVED"? A. OWNER'S TANK I. p 4 COMPLETE ALL ITEMS SPECIFY IF UNKNOWN C. DATE INSTALLED(MO/DAY/YEAR) B. MANUFACTURED 8Y; II.TANK CONTENTS _ D• TANK CApACiTy J IFA-t IS MARKED.COMPLETE ITEM CIN GALLO. NS: # A. I t MOTOR VEHICLE FUEL t ❑ 2 PETROLEUM ❑ 4 OIL } 8. r ❑ 3 CHEMICAL PRODUCT ❑ 80 EMPTY C. ❑ to REGULAR i ❑ 95 UNKNOWN 1 PRODUCT UNLEADED 13 DIESEL D• IF(A.t)IS NOT MARKED, Ib PREMIUM ❑ 4 GASAHOI ❑ 6 AVIATION GAS ENTER NAME OF SUBSTANCE STORED ❑ 2 WASTE UNI DED ❑ 2 LEADED ❑ 5 JET ❑ �METHANOL . III• TANK CONSTRUCTION ❑ OTHER (DESCRIBE IN ITEM D• MARK ONE ITEM ONLY IN BOXES A. BELOW) A. TYPE OF � t DOUBLE WAIL B.AND C. C•A.S.a«; SYSTEM ❑ AND ALL THAT APPLIES IN BOX O AND E ❑ 2 SINGLE WALL 3 SINGLE WALL WITM EXTERIOR LINER ((; ❑ (VAULTED TANK t BARE STEEL TED TANK) 4 SECONDARY CONTAINMENT ❑ 95 UNKNOWN B• I� MATERIAL ❑ 2 STAINLESS STEEL ❑ OTHER S (Primary Tank) ❑ 5 CONCRETE 6 � 3 FIBERGLASS ❑ ❑ 9 BRONZE ❑ POLYVINYL CHLORIDE ❑ 4 STEEL CLAD Wi FIBERGLASS REINFORCED PLASTIC ❑ 70 GALVANIZED STEEL ? ALUMINUM C.INTERIOR ❑ t RUBBER LINED ❑ 95 UNKNOWN ❑ 6 LOTH% METHANOL COMPATIBLE W1FRP LINING ^ 5 GLASS LINING ❑ 2D LINING ❑ 99 OTHER ❑ 6 UNLINED C33 EP IS LINING MATERIOXY LINING AL ❑ 4 PHENOLIC LINING COMPATIBLE WITH 700%METHANOL? 95 N NOWN D.CORROSION ❑ t POLYETHC3 99 OTHER POLYETHYLENE Wgpp PROTECTION CD 2 COATING ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑ 3 VINYL Wggp :•SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) 4 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN V.PIPING INFORMATION tai g' OTHER CIRCLE A IFABOV OVERFILL PgEVENTIONE0UIPMENTINST SYSTEM TYPE EGROUNOOR U IF UNDERGROUND ALLED A U t SUCTION THIFAPPLICABLE (PEAR) CONSTRUCTION q D U PRESSURE MATERIAL AND A U t SINGLE WALL A U 3 GRAVITY ) U DOUBLE WALL A U 9s OTFIER CORROSION BARE STEEL A U 3 LINED TRENCH PROTECTION A U 5 ALUMINUM A U 2 STAINLESS STEEL A U 95 UNKNOWN A U 6 CONCRETE A U 3 POLYVINYL CHLORIDE P A U 99 OTHER LEAK DETECTION A U 9 GALVANIZED STEEL A U t0 CATHODIC PROTECT ON ? STEELWiCOATING ( �)A FIBERG t AUTOMATIC LINE LEAK DETECTOR LASS PIPE ANK LEAK DETECTION A U 9s UNKNOWN A u 8 100%METHANOL ❑2 LINE TIGHTNESS TESTING 3 A U 99 OTHER COMPATIBLE W/FRP I VISUAL CHECK � MONITORING ❑99 OTHER 6 TANK TESTING 2 INVENTORY RECONCILIATION 7 INTERSTITIAL MONITORING ❑ 3 VADpZEMONITORING ❑ ANK CLOSURE 4 AUTOMATIC TANK ❑ 91 NONE GAUGING INFORMATION ❑ 5 GROUND WATER MONITORING (MOI DATE LAST USED(MO � 95 UNKNOWN ❑ 99 OTHER I 2.ESTIMATED QUANTITY OF: FORM HAS B SUBSTANCE REMAINING BEEN COMPLETED UNDER P 3•WAS TANKFI APPLICANTS NAME ENAL TY OF p �"—�LLONS INERT LLED WITH (PRINTED d SIGNATURE) ERJURY,AND T MATERIAL? YES ❑ NO❑ O THE BEST OF q,Jy KNOWLEDGE IS TRUE AND CORRECT L AGENCY USE ONLY THE STATE 1-1).NUMBER IS COMPOSED OFT DATE STATE I.D.# COUNTY# HE FOUR NUMBERS BELOW T JURISp(CT(n # UMBER +�c:-(ILK/j JI `I �JCTIOr ,J� FACILITY# D 6 li TANK PERMIT APPROVED 8Y/OATE THIS FORM MUST BE ACCOMPANIED 8Y A PERMIT APPLICATION-F PERMIT EXPIRATION DATE 97) FILE THIS FORM WITH�y ORM A,UNLESS A CURRENT FORM E LOCAL AGENCY fMP:MENTING THE UNDERGROUND STt1RAGE TANK REGU A HAS�FILED. I � � S �( � l > v— Foaoaoie•R6