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805-549-5544
Facility
Facility
,COtr'r r y OF SAN LUIS OBISPO HEALTH DEPAh' MENT
Division of Environmental Health
P.O. Box 1489, San Luis Obispo, CA 93406
Routine lnspection
Reinspection No.
Complaint lnvestigation
e/.
HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR
INSPECTION REPORT/NOTICE OF VIOLATION
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Contacl Person:-
Title/Position
HAZARDOUS MATERIALS UNDERGROUND STORAGE TANKS (coMP # )
H&S Code, Div. 20,CA H&S Code, Div. 20,6.
BUSINESS I.D. FORM ATL. #- GENERAL
hone number
3. Location of utilities
INVENTORY
4. Hazardous material & amounts listed TANK CLOSURE
5. Material stored in proper containers
& labeled
not stored
containment
PLOT PLAN
8.
9.
Plot submitted
buildi WASTE GENERATORS COMP #streets &
of hazardous materials
11. Fire ishers/water source
12.shut-off switches
Location &of
14. Sewer and/or storm drains
15.
16.
17
18.
19.
uate evacuation rocedures
rocedures
area
ons tn
EMERGENCY RESPONSE PLAN
ate
TRAINING PROCEDURES
The above marked items represent violations of the California Health & Safety Code and the California Code of
Regulations and must be corrected.
#
Viol
2.
7.
Comol Viol Compl-
20. Permit to operate
21. lnvenlorv reconciliation
22. Precision tank test
23. Leak detectors L-/'
24. Permit approved
25. Temoorarv closure
26. Removal/in place abandonment
a) Tanks purqed F,
b) Tanks rinsed
c) Soil samples taken
27. EPA identification number -a28. Variances and/or exemptions t./i A
29. Manifg6ts
30. Waste oil receipt
31. Trainino orooram/records
32. Continoency plan
33.Material stored in proper containers
& labeled
34. lncompatibles not stored toqether
35. Storaqe - 90 davs
36. Fire extinquishers
37. Spill containment
COMMEN
((Ar (:t ;'f-
fi,';;1t /.(tot't.,t'r -, "fl.,r;7', 1 r""
lnspector's Signatu
Owner/Operator Signatu
NOTE: Signature indicates receipt of this
Page- of-
only and not an admission of the facts.
805-549-5544
Facility N
HAZARDOUS MATER IAL/U N DERG ROU N D STORAGE TAN K/WASTE G EN ERATOR
INSPECTION REPORT/NOTICE OF VIOLATION
Data'
/ -/-ti ,i.". r77'ifI
)
COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT
Division of Environmental Health
P.O. Box 1489, San Luis Obispo, CA 93406
Routine lnspection
Reinspection No.
Complaint lnvestigation
Contact Person:-
Title/Position:-
(.-t r:t'r- :-'..'',,. i \t<I.i:,j:: (.-/iFacility Add .....:)l'I}
HAZARDOUS MATERIALS UNDERGROUND STORAGE TANKS (COMP # )
H&S Code, Div. 20,H&S Code, Div. 20,6.
BUSINESS I.D. FORM ATL GENERAL
number
3. Location of utilities
INVENTORY
H material & amounts listed TANK CLOSURE
5. Material stored in proper containers
& labeled
6. lncom ibles not stored her
containment
12.
11
8.
9.
7
Plot
Fire
submitted
PLOT PLAN
streets &bui WASTE GENERATORS COMP
10. Location of h materials
source
shut-off switches
13. Location & verification of MSDS
14. Sewer and/or storm drains
ons tn
EMERGENCY RESPONSE PLAN
evacuation ures
TRAINING PROCEDURES
The above marked items represent violations of the California Health & Safety Code and the California Code of
Regulations and must be corrected.
Viol
2
4.
L-,'
Ad
15.
16.
17.
18.
19.
ComplComplViol
20. Permit to operate
21. lnventorv reconciliation
22. Precision tank test
23. Leak detectors
24. Permit approved
25. Temoorarv closure
26. Removal/in place abandonment
a) Tanks ourqed p.
b) Tanks rinsed
c) Soil samples taken
&,-,/'27. EPA identification number
28. Variances and/or exemplions L.-'
29. Manifests
30. Waste oil receipt
31. Trainino orooram/records
32. Continqencv plan
33. Material stored in proper containers
& labeled
34. lncompatibles not stored together
35. Storaoe - 90 davs
36. Fire extinouishers
37. Soill containment
COMM {
tt
I ::)
'3t
it-rl:,;; ;. ''ia..': ' i, '( ( " t.
,
lnspector's S
Owner/Operator S
facts.NOTE: Signature indicates of this document only and not an admission of the
Page- of-
805-549-5544
Facility N
Facility Address
HAZARDOUS MATER IAL/U N DERG ROU N D STORAGE TAN K/WASTE GEN ERATOR
INSPE TION REPORT/NOTICE OF VIOLATION
Date z. J, /f.,
.//'q)- { { /176-.ro
I
,,-{
COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT
Division of Environmental Health
P.O. Box 1489, San Luis Obispo, CA 93406
Routine lnspection
Reinspection No.
Complaint lnvestigation
Contact Person:-
Title/Position:-*>/- u
ComplComplViol
20. Permit to operate
21. lnventory reconciliation {22. Precision tank test
23. Leak detectors !/'
24. Permit approved
25. Temporary closure
26. Removal/in place abandonment
---1Ja) Tanks purged
b) Tanks rinsed
c) Soil samples taken
WASTE GENERATORS COMP #__I11_Tr?T
27. EPA identification number
28. Variances and/or exemptions
29. Manifests
30. Waste oil receipt
31. Trainino orooram/records ,.rt.
32. Continqencv plan
33. Material stored in proper containers
& labeled
34. lncompatibles not stored together
35. Storaoe - 90 davs
36. Fire extinguishers
37. Spill containment
HAZARDOUS MATERIALS (21 UNDERGROUND STORAGE TANKS (COMP # )
(cA H&S Div. 20, Ch H&S Code, Div. 20,6.
BUSINESS I.D. FORM ATL. #-- GENERAL
number
3. Location of utilities
INVENTORY
4. Hazardous material & amounts listed TANK CLOSURE
Material stored in proper containers
& labeled
bles not stored
containment
PLOT PLAN
L Plot submitted
&buildi
10. Location of hazardous'11. Fire exti uishers/waler source
12.shut-off switches
13. Location & verification of
14.and/or storm drains
15.atea
16.in revtous
EMERGENCY RESPONSE PLAN
17.
18.evacuation
19.TRAINING PROCEDURES
The above marked items represent violations of the California Health & Safety Code and the California Code of
Regulations and must be corrected
4
Viol
2
5.
6.
7.
COMMEN - €':l'>{)
r*(> ?Lt t "i-
't r.,l':,,ct!;'1.:.
c,.
i,t(14 ,{ f:,!
:i (..t)
lnspector's Signatu
Owner/Operator Signatu
NOTE: Signature indicates receipt of this document only and not an admission of the facts.
Page- of-
-"Sid$e oF'CnlipOH"Nirt''+*"' *or.* *=*uRcEs conrno-ooro '''' t'
,{.' FoRM .B': un.oeNCROUND STORAGE TANK PROGRAM
,;r'' TANK TANK PERMIT APPLICATION INFORMATION
COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORiIATION FOR EACH TANK.
l. TANK DESCRIPTION coilplErEALLrrEms-rFuNKNorvN-sospEcrFy
'e
ro
5O,Fats
MARK ONLY
ONE ITEI{
fFl r new ernur
n z rnruRru peRur
n s ner{rwelpenMf
l-l l eueruoeo prnur
5 CHANGEOFINFORMATION
l-l o reuponrRY rANK cLosuRE
I z eenunrurNTLY cLosED TANK
l-l s rnNx nei/oveo
FARM TANK - YES E"oEFACILITY/SITENAilEWHERETANKISINSTALLED: San Luis Qbisoo Service Cenrer
A. OWNERS rANK rD # 1801 2 B. MANUFACTURED BY: TJnknnnrn
c. YEAR TNSTALLED 1957 D. rANK CAPACIry lN GALLONS: 4000
ll. TANK CONTENTS rF (A.1), rs mARKEo, couplErE rrEil c. rF (A.r), rs Nor MARKED, coupLErE rrEm D.
A,lil r uoronvrHrcLEFUEL I z rernoleuu
3 CHEMICAL PBODUCT
5 HAZARDOUS
4 otl
l-l so Er',rpr/ n gs uttxltowt'r
B.
Etr
1 PRODUCT
2 WASTE
c. []t uNLEADED l-l z unoro
l-l s rEr puel
3 DIESEL
6 AVIATION GAS4 GASAHOL
l-l z uernrruoL [ 99 orHER (DESoRTBE rN rrEM D, BELow)
D, IF NOT MOTOR VEHICLE FUEL, ENTER NAME OF
HAZARDOUS SUBSTANCE STORED & C.A.S. #N/A cA.s. #: N/A
lll. TANK CONSTRUCTION ilARKoNErrEmoNLyrNBoxA,B,c,&D
lV. PIPING INFORMATION crRcLE A rFABovEGRouND, u TFUNDERGRoUND,BoTHIFAppLIcABLE
A. SYSTETTYPE A U I r sucrror A U 2 PHESSURE A U 3 GRAVIry A U 91 NONE A U 95 UNKNOWN A U 99 OTHER
B. CoilSTRUCTlol'l A U lSINGLEWALLED A U 2DOUBLEWALLED A U 3LINEDTRENCH A U 91NONE A U gsUNKNOWN A U ggOTHER
a @ r sreer-lrnor AU
AU
AU
2 STAINLESS STEEL
6 CONCRETE
95 UNKNOWN
AU
AU
AU
3 POLWTNYL CHLORTDE (PVC)
7 STEEL CLAD W/FRP
AU
AU
4 FIBERGLASS PIPE A U 91 NONE
8 ,I OO% METHANOL COMPATIBLE FBPC, TATERIAL AU
AU
5 ALUMINUM
9 GALVANIZEO STEEL 99 OTHER
V. LEAK DETECTION SYSTEM crRcLE P FoR pRrMARy, oR s FoR sEcoNDARy, A pRn ARy LEAK DErEcnoN sysrEm Husr BE clRcLED.
VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE
A, TYPE OF
SYSTEII
DOUBLE WALLED l-l s srrue Le wnLLED wTH EnERroR LINER l-l gs uruxruowru
lxl z srcLe wRlLro 4 SECONDARY CONTAINMENT 99 OTHER
B. TAIIK
'TATERIAL
[Xl r srerLlnoru
l-l s corucnm
l-l s anoNzr
l-l z srRruLesssrrrL 4 STEEL CLAD W/FIEERGUSS REINFOBCED PI.ASTIC
8 1000/6 MEIHANOL COMPATIELE FRP
99 OTHER
6 POLYVINYL CHLORIDE
3 FIBERGLASS
7 ALUMINUM
l--| ro onLvnNrzeosrsei ! ss uruxruowu
c. tilTERloR
TINING
4 PHENOLIC LINING
95 UNKNOWN , ,
dn
^TUco
1 RUBBER LINED 2 ALKYD LINING
l-lsolesuruno fl6uNLINED
IS LINING MATERIAL COMPATIELE WITH lOO% METHANOL?
[-l s rlonuNrNe
YES NO
D. CoRRoSr0il
PROTECTIOII
4 FIBERGLASS REINFORCED PLASTIC
99 OTHER
l-l r poLvnnLrur wnm fl z rnn on nseHnLr
5 CATHODIC PROTECTION 91 NONE
3 VINYL WRAP
95 UNKNOWN
PP
P
1 VISUALCHECK P S 2INVENTORYRECONCILIATION
6 PRECISIONTESTING P S 7 PRESSURETESTING
PS
PS
3 VADOSE
91 NONE
S 4 ELECTRONIC MONITOR
S 95 UNKNOWN
PS
PS
5 GROUND WATER MONITORING WELLS
99 OTHERP
1, ESTIMATED DATE LAST USED (MO/YR)2. ESTIMATED QUANTITY OF
SUESTANCE REMAINING IN
GALLONS
3. WAS TANK FILLED WITH
INERT MATERIAL?[ves E*o
THIS FORM HAS BEEN COMPLETED UNDER PENALW OF PERJURY, AND THE BEST OF MY KNOWLEDGE,TRUE AND CORRECT
LOCAL AGENCY USE ONLY
FoRM B (6-29-88) THIS FORT IUST BE ACCOf,PANIED BY A FACITITY/SIIE APPLICATIOII, FORM .A', Ul{LEss A CURREIIT FoRT.A' HAs BEEI{ FILED
DATA PROCESSING COPY
APPLICANT'S NAME (PRINTED & SIGNATURE)
Donald Kennady, Jr.
lrl lrl trltCOUNTY#JUR!SDICTION #AGENCY #TANK ID #rrc,K,oo
CURRENT LOCAL AGEI{CY FACILITY IO #APPROVED BY I{ATE PHONE f WITH AREA COOE
PERIIIT IIUIIBER PERMIT APPFOYAL DATE PERMIT DATE
CHECK f PERHIT AMOUNT SURCHARGE AtrT FEE COOE RECEIPT *BY:
r,i'L . .;)'1
S.i'Eryg'UF CALEIt:Critt$ll-' 'wArER nesouncEs coNrRo-ronno 'r'r .
UNDERGROUND STORAGE TANK PROGRAM
TANK PERMIT APPLICATION INFORMATION
COMPLETE A SEPARATE FORiI WITH THE FOLLOWING INFORMATIOI{ FOR EACH TANK.
l. TANK DESCRIPTION couprErE ALL trEms - tF urKNowN - so spEctFy
FORM'B':
TANK 'z
to
rOAao
MARK ONLY
ONE ITEM
f? r rueweenur
l-l z rurrnu penur
[-l s ner{ewAupEn[r[
4 AMENDED PEBMIT
[-l s cunruee oF TNFoRMAIoN
l-l o rEuponaRY rANK cLosuRE
l-l z prnunrueruTlYcLosEDTANK
8 TANK REMOVED
FARH TANK - YES NOEFACIL!ryS|TE NAiIE WHERE TANK tS |]{STALLED: San Luis Obispo Service Center
A. owNERSrANxror 18013 B.MANUFAcTUREDBY: Unknown
C. YEAR INSTALLED 1957 D. TANK cAPAClry lN GALLONS: 4000
II. TANK CONTENTS rF (A.1), rS ilARKED, COTPLETE rTElr C. rF (A.1), !S NOT I|ARKED, COI|PLETE rTEit D.
,o s] , MoroR vEHrcLE FUEL [-l z pernolEur',r
3 cHEMToAL PBoDUcr l-l + orr-
s HAzARDous l-l so Er'/pr/ l-l ss ur'rxr'rowr'r
B.
lFlr enooucr
2 WASTE
c ETUNLEADED l-lzunoEo
4 GASAHOL 5 JET FUEL
[-l z urrHlruoL I ee orHER (DEscRrBE rN rrEM D, BELow)
3 DIESEL
6 AVIATION GAS
C.A.S. #: N/A
D. IF NOT MOTOR VEHICLE FUEL, ENTER NAME OF
HAZARDOUS SUBSTANCE STORED & C,A.S. #N/A
lll. TANK'CONSTRUCTION ilARK ol{E lrEH oNLy lN Box A, B, c, & D
A, TYPE OF
SYSTET
DOUBLE WALLED
ffi z srueLeweueo
3 SINGLE WALLED WITH EXTERIOR LINER
4 SECONDARY CONTAINMENT
[-l ss ur,rxriowr'r
l--l ss orHrR
B, TANK
TATERIAT
[Tl rsrEeurnoru
n s corcnne
l-l s enoNzE
2 STAINLESS STEEL I s nernoLes 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC
8 1OM METHANOL COMPATIBLE FRP7 ALUMINUM
l-l ss uNrNowr'l [-l ss orHrn
l-l o poLyvrruvLcnlonnr
l-l ro onLvnrurzEosrEr
C. INTERIOR
LrilrilG
[-l r nussrnLrHeo ! 2ALKIDLINTNG
n s eusLrlrue ffi'6 uNLTNED
l-l s ururrue unreRrAl coMpATIBLE wTH 100% METHANoL?
3 EPON LINING 4 PHENOLIC LINING
95 UNKNOWN /
YES No l--l ss orHrn
D. CoRRoSr0N
PROTECTIOII
1 POLYETHLENEWRAP ffi z unoRnsrnlLr
l-l s cnrnoorcpnoTEcTtoN E 91 NONE
f] s vrrwLwnne
! ss ur'rxr'rowru
4 FIBERGI-ASS REINFORCED PLASTIC
99 OTHER
lV. PIPING INFORMATION crRcLE A rFABovEGRouND, u TFUNDERGRouND,BoTHIFAppLTcABLE
A. SYSTETTYPE l(g,)r sucrror,t A U 2 PRESSUFE A U 3 GRAVITY A U 9'1 NONE A U 95 UNKNOWN A U 99 OTHER
B.CONSTRUCTIOi{ l(q)t sINGLEWALLED A U 2DOUBLEWALLED A U 3LINEDTRENCH A U 91NONE A U 9SUNKNOWN A U 99OTHER
C. TATERIAL
n Or sreer-rrnor.r AU
AU
AU
2 STAINLESS STEEL
6 CONCHETE
95 UNKNOWN
AU
AU
AU
3 POLYVINYLCHLORIDE(PVC) A U 4 FIBERGLASSPIPE .A U 91 NONE
7 STEELCLADW/FRP A U 8 lOO%METHANOLCOMPATIBLEFRP
OO NTHFA
A U 5 ALUMINUM
A U 9GALVANIZEDSTEEL
V. LEAK DETECTION SYSTEM crRcLE P FoR pRrMARy, oR s FoR sECoNDARy, A pRrirARy LEAK oErEcnoN sysrEu Musr BE clRcLED.
P
P
P
1 VISUALCHECK P S 2INVENTORYRECONCILIATION
PRECISIONTESTING P S 7 PRESSURETESTING
P S 3 VADOSEWELLS
P S 91 NONE
S 4 ELECTRONIC MONITOF
S 95 UNKNOWN
5 GROUND WATER MONITORING WELLS
99 OTHER
-
PS
PS
VI. INFORMATION ON TANK PERMANENTTY CLOSED IN PLACE
1. ESTIMATEO DATE LAST USED (MO/YR)2, ESTIMATED QUANTITY OF
SUBSTANCE REMAINING IN
GALLONS
3, WAS TANK FILLED WITH
INERT MATERIAL?YES E ruo
THIS FORM HAS BEEN COMPLETED UNDER PENALW OF PERJURY, AND TO BEST OF MY KNOWLEDGE, ISTRUE AND CORRECT,
LOCAL AGENCY SE ONLY
FORM B (6-29.88) THIS FORT TUST BE ACCOTPAIIIED BY A FACITITY/SITE APPTICATION, FORM .A', uNLEss A cuRREl{T FoRH .A' HAs BEEI{ FITED
DATA PROCESSING COPY
OATEAPPLICANT'S NAME (PRINTED & SIGNATUFE)
Donald Kennady, Jr.
ltCOUNTY #JURISDICTION #AGENCY #TANK ID #,ocrrr',v
CURRENT LOCAL AGENCY FACILITY ID *APPROVEO BY NAHE PHONE * WITH AREA CODE
PERUIT NUiIBER PERMIT APPROVAL DATE PERHIT EXPIRATION DATE
CHECK #PERHIT AIIOUNT SURCHARGE ATT.FEE COOE RECEIPT f BY:
,^ STATE OF CALIFORNI/I wArER REsouRcEs coNrRorloARD
FORM'B':UNDERGROUND STORAGE TANK PROGRA]II
TANK PERMIT APPLICATION INFORMATION
COT'PLETE A SEPARATE FORII WITH THE FOLLOWING INFORUATION FOR EACH TANK.
l. TANK DESCRIPTION corpLErE ALL rrEus - rF uNKNowN - so spEctFy
TANK z.
r@
$Cf5o)g)
IIARK ONLY
ONE ITET
Dfl t rEwpEnur
I z ruenru eenur
[-l s neNrwnlprnMr
[-l q rMeNoeo peni/r
5 CHANGE OF INFORMATION
6 TEMPORARY TANK CLOSURE
l_l z prnunrueNrlYcLosEDTANK
8 TANK REMOVED
FACILITY/SITENAilEWHERETANKISINSTALLED: San Luis Obispo Service Center FARMTANK-YesE ro E
A. OWNERSTANK rD# 100055 B. MANUFACTURED BY: TTnlrnnm
c. YEAR TNsTALLED Unknown D. TANK CAPACIry lN GALLONS: 6000
ll. TANK CONTENTS tF (A.r), rs ITARKED, colrpLErE rrEt c. rF (A.1), !s Nor irARKEo, colrpLErE rrEn D.
I [] t Moron vEHtcLE FUEL l-l e pnnouur,t
n s cHrirrcnL PRoDUcr l-l l orr-
! s Hlzmoous l-l so r[apr/ [ ss utlxNowN
B.
lTl r pnooucr
2 WASTE
c. E r UNLEADED
I-l r ensnHol
l-l z t'rnHlruol
2 LEADED lTl g orrsEl
5 JET FUEL 6 AVIATION GAS
l-l ss orHen loEscFrBE rN rrEM D, BELow)
c.A.s. #: N/A
D. IF NOT MOTOR VEHICLE FUEL, ENTER NAME OF
HAZABDOUS SUBSTANCE STORED & C.A.S, #N/A
lll. TANK'CONSTRUCTION mARK or{E rrEr or{Ly rN Box A, B, c, & D
A. TYPEOF
SYSTET
n gs uuxrowru
l--l ss orHER
ffit oouaLrwelLeo
I z sruercweuro
! s sneLr wnLLED wTH EXTERToR LINER
l-l + sccomnnv ooNTATNMENT
B, TAI{K
'IIATERIAT
I STEEL/IRON
n s coucnne
9 BRONZE
lTl l srer cuo w/FTBERGLAss RETNFoRoED pLAsTrc
8 10096 METHANOL COMPATIBLE FRP
99 OTHER
2 STAINLESS STEEL
6 POLWT'IYL CHLORIDE
IO GALVANIZED STEEL
3 FIEERGLASS
7 ALUMINUM
95 UNKNOWN
c. tt{TERt0R
LINING
n r nusseRuNEo !2ALqDLrNrNG
nsousuHrHe ffi6uNLINED
I s Lrutruo ulrtnrAL coMpAlBLE wrTH r0o/6 MEIHANoL?
a
m
4 PHENOLIC LINING .
95 UNKNOWN
, ,
3 EPOXY LINING
YES NO n sg ofin
D. CoRRoSroN
PROTECTIOI{
l-l z rRn on espmlr
[-l sl NoNe
n r porvnn*ruEwRnp
n s cnrHoorc pBoTEcTroN
3 VII.IYL WRAP
95 UNKNOWN 99 OTHER
fl l neeneus RETNFoRcED PLAsTrc
lV. PIPING INFORMATION crRcLE A rFABovEGRouND, u tFUNDERGRoUND,BoTHTFAppLtcABLE
V. LEAK DETECTION SYSTEM crRcLE P FoR pRrMARy, oR s FoR sEcoNDARy, A pRrrARy LEAK DErEcrol{ sysrEu musr BE crRcLED.
PS
PS
1 VISUALCHECK P S 2INVENTORYBECONCILIATION
6 PRECISIONTESTING P S 7 PRESSURETESTING
PS
PS
3 VAOOSE WELLS
91 NONE
S 4 ELECTRONIC MONITOR
S 95 UNKNOWN
PS
PS
5 GROUND WATER MONITORING WELLS
99 OTHER
-
VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE
1. ESTIMATED DATE LAST USED (MO/YR)2, ESTIMATEDOUANTIryOF
SUBSTANCE REMAINING IN
GALLONS
3. WAS TANK FILLED WITH
INERT MATERIAL?YES NO
THIS FORM HAS BEEN COMPLETED UNDER PENALW OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT,
LOCAL AGENCY USE ONLY
FoRM B (6-2e-88) THIS FORil ilUST 8E ACC0HPAilIED BY A FACIIITY/SITE APPllCATlOll,RM A', uilLEss A cuRREt{T FoRt'A' HAs BEEI{ FIIED
A. SYSTETTYPE A 1 SUCTTON A U 2 PRESSURE A U 3 GRAVIry A U 91 NONE A U 95 UNKNOWN A U 99 OTHER
B.CONSTRUCTIOI{ A U lSINGLEWALLED A 2DOUELEWALLED A U 3LINEDTRENCH A U 91 NONE A U gsUNKNOWN A U ggOTHER
AU
AU
AU
,lSTEEL/IRON A U 2STAINLESSSTEEL A
sALUMINUM A U oCONCHETE A
9 GALVANIZED STEEL A U 95 UNKNOWN A
C. f,ATERIAt
99 OTHER
u
u
4 FIBERGLASS PIPE A U 91 NONE
8 1OO% METHANOL COMPATIBLE FHP
AU
AU
3 POLWTNYL CHLORTDE (PVC)
7 STEEL CLAD W/FRP
APPLICANT'S NAME (PRINTED & SIGNATURE)
Donald Jr.
lrl lrl llCOUNTY #JUFISDICTION #AGENCY #TANK ID #rtctuffi *
CURRENT LOCAL AGEI{CY FACILITY ID #APPROVED BY NATE PHONE T WITH AFEA CODE
PERTIT NUTBER PERUIT APPNOVAL DATE PERTIT EXPIRATIOX DATE
CHECK#PERIIT AUOUNT SURCHARGE ATT.FEE CODE RECEIPT f
DATA PROCESSING COPY
STATE OF CALIFORNIf\ wArERREsouRcEscoNrRo^pARD
FORM.B': UNDERGROUND STORAGE TANK PROGRAM
TANK ___T4!!f_PERMlr APPLlcArloN lNFoRMArloN
COiIPLETE A SEPARATE FORT WITH THE FOLLOWING INFORMATION FOR EAC}I TANK.'z
ro
I. TANK DESCRIPTION comPtETE ALL ITEIIIS. IF ulIKNowN - so SPECIFY
5Cfs
ct)
cnA. owNEBs rANK tD # 100054 e.MaNurRcruREDBY: Unkown
C. YEAR INSTALLED 19BB D. TANK oAPACITY lN GALLONS: 550
ll. TANK CONTENTS rF (A.1), rs TTARKED, corprErE lrEr c. rF (A.r), rs Nor ilARKEo, coilprErE rrEM D.
A.1 MOTORVEHICLEFUEL
3 CHEMICALPRODUCT
5 HAZARDOUS
n z pnnoleuu
lTlq orr-
l-l so E[apr/ l-l ss ur'rxr.lowr.r
B.
[-l r pnooucr
lXl z wesre
1 UNLEADED
4 GASAHOL
7 METHANOL
f-l z unoro
l-l s rrr rurr-
3 DIESEL
6 AVIATION GAS
c.
[X I ss oruen loEScRrBE rN rrEM D, BELow)
D, IF NOT MOTOR VEHICLE FUEL, ENTER NAME OF
HAZARDOUSSUBSTANCESTORED&C.A.S.f Waste Motor Oi1 c.n.s. *: $$d/-77-7
lll. TANK CONSTRUCTION mARK ol{E rrEm oNLy rN Box A, B, c, & D
lV. PIPING INFORMATION crRcLE A rF ABovE GRouND, u rF UNDERGRoUND, BorH rF AppLTcABLE
V. LEAK DETECTION SYSTEM crRcLE P FoR pRrMARy, oR s FoR sEcoNDARy, A pRmARy LEAK DErEcnoN sysrEit rusr BE ctRcLED.
VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE
'1. ESTTMATED DATE LAST USED (MO/YB)2. ESTIMATEO QUANTITY OF
SUBSTANCE REMAINING IN
GALLONS
3. WAS TANK FILLED WITH
INERT MATERIAL?YES NO
THIS FORM HAS BEEN COMPLETED UNDER PENALW OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRIJE AND CORRECT.
LOCAL AGENCY USE ONLY
FoRM B (6-29-88) THIS FORT TUST BE ACCOI PAI{IED BY A FACILITY/SITE APPIICATIOil, FORM .A',
UT{LESS A GURREIIT FoRT .A' HAs BEEI{ FITED
DATA PROCESSING COPY
MARK ONLY
ONE ITEM
JTlr ruEwpenur
2 INTERIM PERMIT
l-l s neNewnL peni/F
[-l + nueruoeo pEnurr
5 CHANGEOFINFORMATION
6 TEMPORARY TANK CLOSURE
l-l z penuerurNTLY cLosED TANK
[-l a rerux nruovro
FARII TANK - YES NOEFACILITY/SITENAilEWHERETANKISINSTALLED: San Luis obispo Service Center
A, TYPE OF
SYSTET
[l-r ooueLe wnu-ro
l-l z slcuwnu-eo
3 SINGLE WALLED WTH ENEBIOR LINER
4 SECONDARYCONTAINMENT
95 UNKNOWN
99 OTHER
I r srerLlrnoru
l-l s concnne
l-l s anoNzE
2 STAINLESS STEEL 3 FIBERGLASS
7 ALUMINUM
95 UNKNOWN
lFl l sreeL cLlo t,v/FTBERGLAss RETNFoRcED pLAsTrc
B..TANK
TATERIAL I o roLwrrwLotonroe tr 8 1OOq6 METHANOL COMPATIBLE FRP
99 OTHEB1O GALVANIZED STEEL
l-l r nusaen rHeo [-l z nm{oLnrrue
lFl o uulrueo
3 EPON LINING 4Z
4 PHENOLIC LINING .
95 UNKNOWN /C, IilTERIOR
LINING 5 GLASS LINING
lS LINING MATERIAL COMPATIBLE WITH 10S/6 MEIHANOL?YES n *o [-l ss orHen
D. CoRRoSroN
PROTECTIOII
1 POLYETHLENEWRAP
5 CATHODIC PROTECTION
l-l z rRRonmruRLr
l-l $ Nor'lr
3 VIT{YLWRAP lTl l naencurs RETNFoRoED pl-AsTrc
[-l ss ulrxr'rowl'l 99 OTHER
SYSTETTYPE A 1 SUCTION A U 2 PRESSUFE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER
8.CoNSTRUCTIoN A u 1STNGLEWALLED A 2DOUBLEWALLED A U SLINEDTBENCH A U 9,1 NONE A U gsUNKNOWN A U ggOTHER
A U 1 STEEL/IRON
A U 5 ALUMINUM
A U 9 GALVANIZEDSTEEL
AU
AU
AU
2 STAINLESS STEEL
6 CONCRETE
95 UNKNOWN
A
A
A
4 FIBERGLASS PIPE A U 91 NONE
8 lOO% METHANOL COMPATIBLE FRPC, ]ilATERIAL U
U
AU
AU
3 POLWTNYL CHLORTDE (PVC)
7 STEEL CLAD W/FRP
oo dTuEo
PPS
PS
1 VISUALCHECK P S 2INVENTORYRECONCILIATION
6 PRECISIONTESTING P S 7 PRESSURETESTING
PS
PS
3 VADOSE WELLS
91 NONE
S 4 ELECTRONIC MONITOR
S 95 UNKNOWN
PS
PS
5 GROUND WATER MONITORING WELLS
99 OTHER
Donald Kennad Jr.
APPLICANT'S NAME (PRINTED & SIGNATURE)
rl rrt III rrrcouNw#JUR|SD|CTTON #AGENCY#FACTUTY!D TAI{K ID #
CURRENT LOCAL AGENCY FACILITY ID #APPROVED BY NATE PHONE * WITH AREA CODE
PERf,IT NUtrBER PERMIT APPFOVAL DATE PERHIT EXPIRATIOil OATE
CHECK#PENTIT AHOUIIT SURCHARGE ATIT.FEE CODE NECEIPT }BY:
:I