Laserfiche WebLink
2.TRrl CO EN'! RESOURCE DEPT TO <br /> v <br /> STATE OF CALNORHA .•. <br /> STATE WATER RESOURCES CONTROL90ARO <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B `a <br /> COMPLETE A SEPARATE FORM FOR EACN TANK SYSTEM `'I^ <br /> MARK ONLY / NEW PERMIT O T RENEWAL PERMIT O E CNANOC OF wFORMATgN <br /> ONE REM 2 INTERIM PEArt MO A AMENDED PERMIT O 4 TEMPORARY E TANK OLOSU. ❑ f E LY CLOSED CK yrrf <br /> ❑r /r PRNANH- <br /> TAW REM09E0 <br /> DBA ORPACILRYHAW WHERE TANK191N4TALLED: B<JJCrb TaN4k_ L/NE qNd LduISD.V TUCIG/,✓<j <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY V UNKNOWN <br /> A, OWNEFf TANK LO.• / <br /> 9. WC NUlACTUpfO SY• O DO�6Y ALL <br /> Q. DATE INSTALLED(MO•DAT/TEAR) G _/ — 93 0. TAW CAPACITY IN GALLONS. <br /> II.TANK CONTENTS KAoisMARKEO.CGNPlETE1TBMC. <br /> A. ® I MOTOR VEHICLE FUEL O A CR 9. ❑ to REGULAR ,�r <br /> ❑ i riTROLEUM c' UNLEA01Z 2_$ 3 OQSIL f AVIATIONGL5 <br /> ❑ W EMPTY ® t PRODUCTIm to PREMIUM <br /> II A GASANOL <br /> ❑ i CNEMK%AI PRppLJDi ❑ 9f VNKNDWN ❑ 2 WASTE UNLEADED (i 5 JET FUEL I`J 7 M£TNANOL <br /> O a LEADED (' 90 GTMiq IOi 3Ca:HE IN IRM 7. 9ElOWI <br /> D. IF(A.q ISMpTMARKEO. ENT14 NAME DWSUBSTANCE STOAEo <br /> C.A S.c <br /> IR. TANK CONSTRUCTION Ma'"No ITEMONLYMBOX"A-CANOC.ANDALLTNATAPPLINSINPONO ANOE <br /> A. TYPE OF ® ' COWLE WALL ❑ 7 SINGLE WALL WIN EaTfROA LINER ❑ 95 UNKNOWN <br /> $ISTEM ❑ x 344L2 wAll A SECONOART CONTANMENT 1VAVLTEOTANq ID 99 OThEA <br /> 8. TANK ❑ ' &ARE STEEL ❑ 2 STAJNLES9 STEEL ® a 9189ACLASS ❑ A STfiL CLAD w'FIBEACLASS AiINc . <br /> v CED PLAT{ <br /> MATERIAL ❑ f OohcgETE A POLWInYL CIIORIx ) ALULIMUM ® d 1099, METNPNOL COMPATIALE WISAP <br /> (PKwuyTN) ❑ R SKONZE ❑ 10 GALVANIZED STEEL ❑ 93 uN10•own <br /> 90 07MEq <br /> __. -. -_.. .. . _...__—. <br /> D.RRERgR ' "WSEq LIKEDC 2 ALK7LININGElININO •uENONENO <br /> 0 CA7 3 EPO1K L ❑ . LC..Lw. NOwG.. ...... <br /> LINING ❑ S GLASS LIMING ❑ A UNLINED ❑ 93 UNKNOWN �1 w OrHiR Fi6ar �[ays <br /> U LINING MATEKML OOM►ATI <br /> ElE w1TH tOPN METNAMOLT Yes— NO_ ' <br /> D,CORROSION ❑ POL'TETHTLSNF WRAP CT 2 COAT.ID ❑ 3 Vwn WRAP A cIAERaLASS ANINFORCED PLASTIC <br /> PROTECTION a S C►TNOOICPAOTECTON91 NONE <br /> n Q•! UNKNOWN oo OTME■ <br /> I-SPILL AND OVERFILL $v%LcvNTAr131fNTNSrau10(YEA1) – OvERFALPgEYENIgNiO--- ---- — — <br /> E ALLEO(YEAgI <br /> IV.PIPING INFORMATION CIRCLE AIFASOVEOAOUIOOAU/L9DEq¢gpuNp.PpryyywL CAME <br /> A. SYSTEM TYPE A Y t SVCTON A(D 2 PRESSURE A Y 3 GRAVITY <br /> A U K OTL FR <br /> B. CONSTRUCTION A Y T swoC f WALL A©2 OOUSLE WALL A Y a LINED TRENCH a u 93 uNKrgwN <br /> A V W ONE* <br /> G MATRRIAL AND A Y t BARE fT[CL A U 2 STAINLESS STfFI l Y 3 I'OlwwYl CMLORI0E fP'CI a A u9CAGIAS9 PIPE <br /> CORROSION A Y S ALUMINUM a Y 9 CO•ICAETE A Y 7 STEEL W70OATwG <br /> PROTECTION A Y 9 aAL9AN1210 S7FEt A U IO CATNO010 FIIOTECTOM A U E fOL7. METNANOI DOMPATI4f WIf RP <br /> 4 V 93 LIMING WN A V M OTHER <br /> 0. LEAK OETEGTgN ❑ 1 AUTOMATKLINE IE"oviCbA i LINE TKSMMESSTESTwO ❑ I ^ — <br /> LJNROPrIC J w or•.Eq <br /> V.TANK LEAK DETECTION <br /> ❑ I VISUAL CHECK ❑ x INVENTORY RECONCM1IATH0N ❑ 3 VADo2E MONITCRWG p� . wTOruTK TAN[GLKiINp ❑ ! OAOVnO WATEfl NOMTOgINp <br /> A TANK TnrlMa ® 7 NrEa9TIT%AL MONrrOAPAG <br /> G 91 NONE (J 93 UMCNOWN <br /> >A OTNEA <br /> VI.TANK CLOSURE INFORMATION <br /> t E5TwATEp DATE LAST USEgY1Y 2.ESTIMATED <br /> OWMTTY NOF <br /> V7sWSTANCE REMAINING 13,WAS TAN,(FKLEO WIN YEY ❑ ❑ <br /> GALLONS INERT MATERIAL 7 NO <br /> THIS hbRM HAS BEEN OMPLE7E0 UNDER OENAL7Y OF PFRJURY ANO 70 TM <br /> AP►LOANT'YN.ME __�--, E®ESrOFMYKNOwLEOGf. /SYRUEaNOCORRECT <br /> IrIrITAPA•MAAIVAO OAit <br /> 93ediA! E G n c _ <br /> LOCAL AGENCY USE ONLY Tho STATE I.D.NUMBER IS COMPOSED OF THE POUR NUMBERS BELOW <br /> STATE 1-01couNr y o JURISDICTION P —� <br /> PE I NMMA I PERMIT N/ApYE�EYIDATE / <br /> MT EKPIuTK3N C.rE <br /> mama (7-91) THIS FORK MUST BE ACCOMPANIED BY A PERMIT AP <br /> •FORMA.UNLESS A CURRENT FORMA HAS PEENF�IIKLEOO.. `{ <br /> 00 39Cd 'OOSSV T A7NtfW ANVW E899-8bb-9T6 Eb:L0 E66T/6Z/40 <br />