BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNI1' WATER RESOURCES CONTROP 'BARD FORM `B': UNDERIOROUND STORAGE TANK PROGRAM .o TANK (/ TANK PERMIT A CATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLO I G INFORMATION FOR EACH TANK. ZO MARK ONLY ❑ 1 NEW PERMIT ❑3 RENEWAL PERMIT CHANGE OF INFORMATION ❑ 7 RMANENTLY CL NK ONE ITEM � 2 INTERIM PERMIT ❑4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE e TANK REMOVED � FACILITY/SITE NAME WHERE TANK IS INSTALLED: 1 5� �S ARM NK-YES❑ NO W I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY Oo Oo A. OWNERS TANK ID# B. MANUFACTURED BV: G YEAR INSTALLED D. TANK CAPACITY IN GALLONS: 11. TANK ONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,OMPLETE ITEM D. A. 1 MOTOR VEHICLE FUEL 2 PETROLEUM B. C. 1 UNLEADED ❑2 LEADED 3 DIESEL F-13 CHEMICAL PRODUCT 4 OIL VRODUCT ❑4 GASAHOL 5 JET FUEL ❑6 AVIATION GAS ❑5 HAZARDOUS 80 EMPTY ❑95 UNKNOWN ❑2 WASTE ❑7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.C I HAZARDOUS SUBSTANCE STORED&C.A.S.# Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,8 D A. TYPE OF F-] DOUBLE WALLED ❑ 3 SINGLE WAILED WITH EXTERIOR LINER F-1 95 UNKNOWN SYSTEM 2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ❑ 99 OTHER 1 STEELIIRON ❑2 STAINLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/RBERGIASS REINFORCED PLASTIC B.TANK 5 CONCRETE 6 POLYVINYLCHLORIDE ❑ 7 ALUMINUM ❑8 100%METHANOL COMPATIBLE FRP MATERIAL 9 BRONZE 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER ❑ 1 RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING n YPHENOUG UNING C LIN INTERINGGR ❑ 5 GLASS LINING ❑6 UNLINED 9 UNKNOWN [:]IS LINING MATERIAL COMPATIBLE WITH IDG%METHANOL? YES F]NO 990THER D. CORROSION ❑ 1 POLYETHLENE WRAP ❑2 TAR OR ASPHALT VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 5 CATHODIC PROTECTION ❑91 NONE 95 UNKNOWN ❑ 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE AU 95 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A jl 6 CONCRETE A U T STEEL CLAD W/FRP A U B IOD%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A{(�� 95 UNKNOWN A U 99 OTHER LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. ♦'gP)S 1 VISUAL CHECK P S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS 'S 5 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P 8 95 UNKNOWN P 8 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1.ESTIMATED DATE LAST USED(MOIYR) 2. ESTIMATED QUANTITY OF T3.-WAS TANK FILLED WITH SUBSTANCE REMAINING INGALLONS INERT MATERIAL? E]YES E] NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. APPLICANT'S NAME(PRINTED 8 SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY# JURISDICTION# AGENCY# FACILITY ID B TANK ID# =1 o CURRENT LOCAL AGENCY FACILITY ID# APPROVED BY NAME PHONE x WITH AREA CODE PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE SII � m CHECKkPERMIT AMOUNTI SURCHARGE AMT. FEE CODE RECEIPTp BC, `5 b FORM B S-29-831 THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE APPLICATION, FORM `A',UNLESS A CURRENT FORMA' HAS BEEN FLLED DATA PROCESSING COPY