COMPLIANCE INFO_1997-2002 - Laserfiche WebLink

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r STATE OF CALIFORNIA "`� ••••.`°ot STATE WATER RESOURCES CONTROL BOARD ay g UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM 8 tl� COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. cam`'•'"" MARK ONLY i NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 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: '`RevGxc L0 3 ,. 1. TANK DESCRIPTION COMPLETE ALL ITEMS-SPECIFY IF UNKNOWN A OWNERS TANK 1.D.It 2 B. MANUFACTURED BY: eve P� C. DATE INSTALLED(MCVDAY/YEAR) 8,0,% 0 , . , r D. TANK CAPACITY IN GALLONS: \,2 o o U II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. -* S \e< 2 2,OU 0 �� G��\- us,--r A 1 MOTOR VEHICLE FUEL ® 4 OIL B C. 1a REGULAR UNLEADED a 3 DIESEL ❑ 6 AVIATION GAS ib PREMIUM UNLEADED ❑ 4 GASAHOL 7 METHANOL ❑ 2 PETROLEUM ❑ 80 EMPTY 1„PRODUCT tc MOGRADE UNLEADED S JET FUEL ❑ 8 M85 ® 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ® 2 LEADED H 99 OTHER(DESCRIBE IN ffEM D.BELOW) 0. IF(Al)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED III. TANK CONSTRUCTION MARK ONE ITEM-ONLY IN BOXES A.B.AND C,AND ALL THAT APPLIES IN BOX D AND E A.TYPE OF t DOUBLE WALL ❑ 3 SINGLE-WALL WITH EXTERIOR LINER ❑ g INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ .4 SINGLE.WALLIN A VAULT -OTHER ,. B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL 3 FIBERGLASS ® 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ® 5 CONCRETE 8 POLYVINYL CHLORIDE 7 ALUMINUM ❑ 8 100x. METHANOL COMPATIBLE W/FRP (Primary Tank) 9 BRONZE ❑ 10 GALVANIZED,STEEL ❑.95 UNKNOWN ;❑ 99 OTHER y 1 RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING t 4 PHENCk C`LINING C.INTERIOR ❑ �®y ❑ _. _ ❑ LINING OR ❑ 5 GLASS LINING ice." UNLINED ❑ 95 UNKNOWN ;'❑ 99 OTHER COATING n, ... . IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL 7 YES_.NO® , r, D.EXTERIOR -_ ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING „ _ ❑ 3 VINYL WRAP . 4 FIBERGLASS REINFORCED PLASTIC CORROSIONjj' PROTECTION ❑ S CATHODIC PROTECTION ❑ 91 NONE_ ❑95 UNKNOWN. ❑ 99 OTHER E SPILL AND OVERFILL,etc SPILL CONTAINMENT IN¢TALLED(YEAR) OVERFILL P5fiVENTION EQUIPMENT INSTALLED(YEAR) DROP TUBE YES NO STRIKER PLATE YES Vo' DISPENSER CONTAINMENT YESvll�� NO IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A, SYSTEM TYPE A U 1 SUCTIONU 2 PRESSURE "A U 3 GRAVITY A'U -4 FLEXIBLE PIPING-A•U"99 OTHER " B. CONSTRUCTION A U 1 SINGLE WALL A CU 2 DOUBLE WALL%7r A 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 (U FIBERGLASS PIPE CORROSION A U S ALUMINUM A U 6 CONCRETE 'A U 7 e STEEL W/COATING A U 8 100%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 0 1 M10 MM U l*tEAK 2 M M4TNESS tA 3 CWnHucus aeTERSTRIAI MP 4 EIECIRpaC uaE. Aurowenc PU ❑ DETEcroR ❑ TESNW MoNToR+<t '[FAK oETECTaI sHUTDovm - 99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 RECO CILIUAL ATTIIONORY ❑ 3 MONI ORING ❑ 4 GAUGING AUTOMATIC TANK ®S MONITORINGTER ❑8 TE�NGTANK CONTINUOUS INTERSTITIAL ® 8 SIR ❑ 9 WEEK LY INUUAL❑10 L4 NTHLLY TANK ❑ 95 UNKNOWN ❑99 OTHER TING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL? YES ❑ NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNERS NAME �� DATE (PRINTED t SIGNATURE) ( \\\\`Pi \1 _ � LOCAL AGENCY USE ONLYvVTHE STATE I.D.NUMBER IS MPDS-EVD OF THE FOUR NUMB S BELVW -1 COUNTY 6 JURISDICTION N FACILI A TANK K STATE ILD:# �❑ ❑_❑ I T-F i ii ii PERMIT NUMBER PERMIT APPROVED SY/OATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCA71ON-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED.FORM C MUST BE COMPLETED FOR INSTALLATIONS.THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLW THIS FORM WITH THE LOCAL AGENCY IMPLEMENTINQ THE UVWGROUND STORAGE TANK REGULATIONS FORM 8 (6.95)