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UST Tank Page 1 I..i Formerly SWRCB Form B Complete the UST-Tank pages for each tank for all new permits, permit changes, closures and/or any other tank information change. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any changes. For compartmentalized tanks, each compartment is considered a separate tank and requires completion of separate tank pages. Refer to 23 CCR 32711 for state UST information and permit application requirements. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR,Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER-Leave this blank. This number is assigned by the CUPA. This is the unique number which identifies your facility. 3. BUSINESS NAME-Enter the full legal name of the business. 430.TYPE OF ACTION-Check the reason the page is being completed. For amended permits and change of information, include a short statement to direct the inspector to the amendment or changed information. 431. LOCATION WITHIN SITE-Enter the location of the tank within the site. 432. TANK ID NUMBER-Enter the owner=s tank ID number. This is a unique number used to identify the tank. It may be assigned by the owner or by the CUPA. 433.TANK MANUFACTURER-Enter the name of the company that manufactured the tank. 434. COMPARTMENTALIZED TANK-Check whether or not the tank is compartmentalized- Each compartment is considered a separate tank and requires the completion of separate tank pages. 435. DATE TANK INSTALLED-Enter the year and month the tank was installed. 436.TANK CAPACITY-Enter the tank capacity in gallons. 437. NUMBER OF TANK COMPARTMENTS- If the tank is compartmentalized, enter the number of compartments. 438.ADDITIONAL DESCRIPTION-Use this space for additional tank or location description. 439. TANK USE-Check the substance stored. If MOTOR VEHICLE FUEL, check box 1 and complete item 440, PETROLEUM TYPE. 440. PETROLEUM TYPE- If box 1 is checked in item 439, check the type of fuel. 441. COMMON NAME-For substances that are not motor vehicle fuels(box 1 is NOT checked in item 439), enter the common name of the substance stored in the tank. 442. CAS#-For substances that are not motor vehicle fuels(box 1 is NOT checked in item 439),enter the CAS(Chemical Abstract Service) number. This is the same as the CAS#in item 209 on the Hazardous Materials Inventory-Chemical Description page. 443.TYPE OF TANK-Check the type of tank construction. If type of tank is not listed, check Aother_and enter type. 444. TANK MATERIAL(PRIMARY TANK)-Check the construction material of the tank that comes into immediate contact on its inner surface with the hazardous substance being contained. If the tank is lined do not reference the lining material in this item. Indicate the type of lining material in item 446. If type of tank material is not listed, check Aother=_and enter material. 445.TANK MATERIAL(SECONDARY TANK)-Check the construction material of the tank that provides the level of containment external to, and separate from, the primary containment. If type of tank material is not listed, check Aother=_and enter material. 446.TANK INTERIOR LINING OR COATING-If applicable, check the construction material of the interior lining or coating of the tank. If type of interior lining or coating is not listed,check Aother_and enter type. 447. DATE TANK INTERIOR LINING INSTALLED-If applicable, enter the date the tank interior lining was installed. This is to assist the CUPA to develop an inspection schedule. 448.OTHER TANK CORROSION PROTECTION-If applicable, check the other tank corrosion protection method used. If other corrosion protection method is not listed, check Aother_and enter method. 449. DATE TANK CORROSION PROTECTION INSTALLED- If applicable, enter the date the tank corrosion protection method was installed. This is to assist the CUPA to develop an inspection schedule. 450.YEAR SPILL AND OVERFILL INSTALLED-Check the appropriate box and enter the year in which spill containment,drop tube, and/or striker plate was installed. CHECK ALL THAT APPLY. 451.TYPE OF SPILL PROTECTION-Enter the type of spill containment, drop tube, and/or striker plate. FOR CUPA USE ONLY. 452.YEAR OVERFILL PROTECTION EQUIPMENT INSTALLED-Check the appropriate box and enter the year in which overfill protection was installed or whether there is an exemption from overfill protection. CHECK ALL THAT APPLY, unless tank is exempt. 453. TANK LEAK DETECTION(SINGLE WALL)-For single walled tanks, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ALL THAT APPLY. If leak detection system is not listed, check Aother and enter system. 454.TANK LEAK DETECTION(DOUBLE WALL)-For double walled tanks or tanks with bladder, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ONE ITEM ONLY, 455. ESTIMATED DATE LAST USED-For closure in place,enter the date the tank was last used. 456. ESTIMATED QUANTITY OF SUBSTANCE REMAINING IN TANK-For closure in place,enter the estimated quantity of hazardous substance remaining in the tank(in gallons). 457.TANK FILLED WITH INERT MATERIAL-For closure in place, check whether or not the tank was filled with an inert material prior to closure. ATTACHMENTS- 1. Provide a scaled plot plan with the location of the UST system, including buildings and landmarks. 2. Provide a description of the monitoring program. �vfti .�