BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

nt'ns STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYS I ENI MARK ONLY _I 1 NEW PERMIT 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 C3 I DBA OR FACILITY NAME WHERE TANK IS INSTALLED: � % 7 T uui r%r!gf%nin rtmAl - , ,Tc -a _ SPSCICV IG UNKNOWN A OWNER'S TANK I. D. # I 8. MANUFACTURED BY: C DATE INSTALLED (MO/DAY/YEAR) / C� ?� I 0. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IFA -1 IS MARKED. COMPLETE ITEM C. CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND. BOTH IF APPLICABLE ^I ❑ A [X1 MOTOR VEHICLE FUEL ❑ 4 OIL B, C ❑ to REGULAR UNLEADED a DIESEL L ❑ 6 AVIATION GAS 80 F7 2 PETROLEUM EMPTY ❑ }�1� 1 PRODUCT y� lb PREMIUM UNLEADED 72 ❑ 5 JET FUEL 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑I 2 WASTE LEADED _j 99 OTHER (DESCRIBE IN ITEM D. BELOW), D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED ❑ 8 100°/ METHANOL COMPATIBLE W/FRP C. A. S. III: ❑ 9 BRONZE El10 GALVANIZED STEEL ❑ 95 UNKNOWN jam. III TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A S. AND C AND ALLTHAT APPLIES IN BOX D AND E IiG GQ/V /C 2 CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND. BOTH IF APPLICABLE ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN A. TYPE OF�/ SYSTEM Irl 2 SINGLE WALL 174 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER C. MATERIAL AND J 1 BARE STEEL ❑ 2 STAINLESS STEEL x 3 FIBERGLASS ❑ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC B. TANK ❑ 5 CONCRETE A U 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100°/ METHANOL COMPATIBLE W/FRP MATERIAL (Primary Tank) ❑ 9 BRONZE El10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR ❑ 5 GLASS LINING Ix6 UNLINED ❑ 95 UNKNOWN El 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WI H 100q METHANOL? YES_ NO_ D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) _ 3 VINYL WRAP ❑ 95 UNKNOWN 4 FIBERGLASS REINFORCED PLASTIC 99 OTHER OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION p 4> PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION `S.% 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER U 3 POLYVINYL CHLORIDE (PVC) A 6� FIBERGLASS PIPE C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100Y METHANOL COMPATIBLE W/FRP CORROSION PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER INTER AL AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING ❑ J MONFORING ❑ 99 OTHER D. LEAK DETECTION 711 V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK X 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 1/16 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN 99 OTHER VI. TANK CLOSURE INFORMATION 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES a NO ❑ 1. ESTIMATED DATE LAST USED (MO/DAY/YR) SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT DATE APPLICANTS NAME (PRINTED d SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # 1 I TANK # 0D?' STATE 04 PERMIT 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 BEEN FILED.' f t 1 CJS FOR00348-RS 97