BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

STATE OFCALIFORMA -� .%" ""'•r`�� STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH NK SYSTEM. MARK ONLY ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT S CHANGE OF INFORMATION ❑ 7jPEV CLOSED ON 1 ONE ITEM ❑ 2 INTERIM PERMIT ❑ A AMENDED PERMIT ❑ 8 TEMPORARY TANK CLOSURE ❑ 8ED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 3 . (��. I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.a S. MANUFACTURED BY: C. DATE INSTALLED(MOrDAYNEAR) D. TANK CAPACITY W GALLONS: Q II.TANK CONlfENTS IF A•1 IS MARKED.COMPLETE ITEM C. A. IMOTOR VEHICLE FUEL Q A OIL B. C. la REGU R 8 3 DIESEL ❑ 8 AVIATICN GAS 2 PETROLEUM 80 EMPTY 1 PRODUCT -UNLEA0E0 S AFUELOL ❑ 7 METHANOL F-1UNKNOWN3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM 0. BELOW) 0. IF(AL 1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.AS,•: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A B.AND C.AND ALL THAT APPLIES IN BOX 1 DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER A. TYPE OF ❑ ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ A SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK ❑ I BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ A STEEL CLAD W /FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ I RUBBER LINED ❑ 2 ALKYD LWWG ❑ 3 EPDXY LINING ❑ A PHENOLIC LINING LINING ❑ 5 GLASS LINING ❑ 8 UNLINED ❑ 96 UNKNOWN a 29 OTHER IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL 7 YES_ NO— D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING 3 VINYL WRAP ❑ A FIBERGLASS REINFORCED PLASTIC PROTECTION a 5 CATHODIC PROTECTION ❑ 91 NONE ❑95 UNW40WN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IF ABOVE GROLINO OR U IF UNDERGROUND.BOTH IF APPLICABLE 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 A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 RARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U A FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 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 ❑ I AUTOMATICLINELEAKDETECTOR ❑ 2 LINE TIGHTNESS TESTING3 W ML ❑ MONROR9IG ❑99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING❑ A AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING ❑ 8 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MOAOAY/YR) 2.ESTIMATED OUANTTTY OF 7.WAS TANK FILLED WITH SUB STAN CE REMAINING GALLONS 1 INERTMATERIAL7 YES ❑ NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME IPNNTEC a SKJUTIIHE) GATE d� / I LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY x JURISOICTION x FACILITY 8 TANK A (30 STATE I.D.; r�TTi� 0 PERMITNUMBER ('� IPERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORMS (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. 1 FOAOTOa6Rt