Laserfiche WebLink
A , WATER RESOURCES `;OARD <br /> STATE OF CALIFORNI <br /> FORM 'B': LIND�AGROLIND STORAGE TANK PR6TrRAM <br /> TANKTANK PERMIT APPLICATION INFORMATION ® � I <br /> A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. <br /> COMPLETE <br /> MARK ONLY �1 NEW PERMIT �3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED TANK <br /> ONE ITEM 0 2 INTERIM PERMIT � 4 AMENDED PERMIT 6 TEMPORARY CLOSURE 6 TANK REMOVED ` 1 <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: CAL/I' T " M��-� 1 1 E� FARMTANK-YES NO 7 <br /> I© <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY <br /> A. OWNERS TANK ID# B. MANUFACTURED BY. S C-C> <br /> C. YEAR INSTALLED VOI D. TANK CAPACITY IN GALLONS'. (Zcx�>cp <br /> 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. ~ <br /> 1� <br /> A. 1 MOTOR VEHICLE FUEL 2 PETROLEUM B. C. 1 UNLEADED 2 LEADED 3 DIESEL <br /> 3 CHEMICAL PRODUCT 4 OIL / 1 PRODUCT ❑ 4 GASAHOL 6 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS 80 EMPTY 0 95 UNKNOWN 2 WASTE ❑7 METHANOL E:] 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.# C.A.S.#: <br /> .111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,8 D <br /> A.TYPE OF 1 DOUBLE WALLED 3 SINGLE WALLED WITH EXTERIOR LINER 95 UNKNOWN -- <br /> SYSTEM 2 SINGLE WALLED 4 SECONDARY CONTAINMENT 99 OTHER <br /> 1 STEEL/IRON 2 STAINLESSSTEEL 3 FIBERGLASS 4 SFEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B.TANK 5 CONCRETE 6 POLYVINYLCHLORIDE F-I 7 ALUMINUM F_� B 100%METHANOL COMPATIBLE FRP <br /> MATERIAL <br /> 9 BRONZE E] 10 GALVANIZED STEEL E]95 UNKNOWN E]99 OTHER <br /> 1 RUBBER LINED LKYD LINING El 3 EPDXY LINING F__] 4 PHENOLIC LINING <br /> C. INTERIOR <br /> F-1 LINING 5 GLASS LINING 6 UNLINED D 95 UNKNOWN <br /> ISLINING MATERIAL COMPATIBLE WITH 100%METHANOL? 0 YES ❑ NO ❑99 OTHER <br /> D.CORROSION ❑ 1 POLYETHLENE WRAP 2 TAR OR ASPHALT E] 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION 0 5 CATHODIC PROTECTION 91 NONE 95 UNKNOWN R 99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U 99 OTHER <br /> B. CONSTRUCTION A U 1 SINGLE WALLED AJW2 DOUBLE WALLED A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE <br /> C. MATERIAL A U 5ALUMINUM A U 6CONCRETE A U 7STEEL CLAD W/FRP A U8100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A U 95 UNKNOWN A&99 OTHER {-L-40K 164X=— lQLArs!p d <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> P S 1VISUAL CHECK P S 2 INVENTORY RECONCILIATION P 8 3VADOSE WELLS P®4 ELECTRONIC MONITOR P S 5 GROUNDWATER MONITORING WELLS <br /> P 8 6 PRECISION TESTING P 8 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN M9299 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED OUANTITY OF 3,WAS TANK FILLED WITH <br /> SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? E]YES ❑ NO <br /> THIS FORM fk4S BEEN MPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> P I ANT' M PRINTED&SIGNATURE) _ ;6ATE /yY <br /> LOCAL AGEN Y USE NLY 1 <br /> COUNTY# JURISDICTION# AGENCY# FACILITY ID# (0 TANK ID# <br /> m n b 5 3 3 <br /> CURRENT LOCAL AGENCY FACILITY ID# APPROVED BY NAME PHONE#WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> NECK# PERMIT AMOUNT iURCHARGE AMT. FEE CODE RECEIPT# BY: <br /> FORM B(3-7-96) THIS FORM MUST BE ACCOMPANIEU u A FACILITY/SITE APPLICATION, FORM 'A',UNLESS A ENT FORMA' HAS BEEN FILED <br /> DATA PROCESSING COPY <br />