BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD � UNDERGROUND STORAGE TANK PER , A ICATION - FORM B COMPLETE A SEPARATE FORM FOR NK S STEM MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMITINFORMATION E:] 7 PERMANENTLY CLOSED ONSITE 5 ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT PO Y TANK CLOSURE ❑ 8 TANK REMOVED Z DBA OR FACILITY NAME WHERE TANK IS INSTALLED: K l nei iA laAA ge,�;pr I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNK A OWNERS TANK I.D.# unK__ . MANUFACTURED BY: C. DATE INSTALLED(MOA7AYNEAR) wl,r- D. TANK CAPACITY IN GALLONS: 000 ILTANKCONTENTS FA-IIS MARKED.COMPLETEI C. 1a REGULAR ` DIESEL A ❑ 1 MOTOR VEHICLE FUEL � B. ❑ UNLEADED ❑ 9 AVIATION GAS ❑ 2 PETROLEUM ❑ EMP 1 PRODUCT ❑ lbPREMIUM EADED 5 JET FUEL ❑ 7 METHANOL ❑ 3 CHEMICALPRODIJCT 05 LIN10J0 2 WASTE EV2 LEADED 99 OTHER (DESCRIBE IN ITEM D.Bnom D. IF(A.1)IS NOTMARKED, ENTER NAME OF SUBSTANCE STO C.A S.0: III. TANK CONSTRUCTION LIARKON ITEM ONLY IN BOXES A B.ANDC.ANDALLTHATAPNkWIN BOX A. TYPE OF ❑ 1 DOUBLE WALL 3 SINGLE WALL WITH EXTERIO LINER 5 WN SYSTEM ❑ 2 SINGLE WALL SECONDARY CONTAI NT (VA DTANK) 9D O E ❑ 1 BARE STEEL 2 STAINLESS STEaRl ,=IGNU 9 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B. TANKMATERIAL ❑ 5 CONCRE a POLYVINYL CHL 800% METHANOL COMPATIBLEWFRP (PrimaryTenk) ❑ 9 BRONZE ❑ 10 GALVANDE SUN W R ❑ 1 RUBBE ❑ 2 ALKYD L G EPO LIN 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS INING ❑ 6 UNLIN 95 UN 99 OTHER LINING 94 MATER COMP TIBLE WITH 100% THAN OL YE8_ NO— D.CORROSION E W ❑ 2 COATING ❑ VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 5 IC P TECTION ❑ 91 NONE UNKNOWN ❑ 99 OTHER IV.PIPING INFO A CIFIC4 A IFABOVEGROUNDOR U IF UNDERGROUND.BOTH IFAPPLK:ABLE A SYSTEM TYPE A 4 IsUIETK7 A U 2 PRESSURE A U 3 GRAVITY A U 00 OTHER B. CONSTRUCTION A 1 NGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 99 OTHER C. MATERIAL AND 1 BA EEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A ALUMINUM A U a CONCRETE A U 7 STEELW/ 0ASN10 A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U VANUED STEEL A U 10 CATHODIC PROTECTION A U 99 OTHER D. LEAK DETECTION ❑ 1 AaOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3 MONRORINO ❑ 99 OTHERwIll V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING❑ 4 OMATIC TANK GAUGING[:] 5 GROUND WATER MONITORING E] 6 TANK TESTING ❑ 7 INTERSTITIALMONITORING ❑ 91 NONE 06 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAWYR) 2.ESTIMATED OUANTITY OF 3.WAS TANK FILLED WITH SUB STANCE REMAINING GALLONS INERT MATERIAL YES ❑ No[::] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAME DATE (PRINTED A SK.NAMW LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.# KW (( 1 5 O UJ O� VA PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE FORM 8 (9.90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. F0RXMBfA✓^//'