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i <br />• System Type; <br />N Construction: <br />suction, pressure, and gravity <br />single -walled, double -walled, lined -trench, etc. <br />—K Material Type; <br />steel -iron, stainless-steel, fiberglass, etc. <br />Piping (cross-sectional diagram, including connections to tends and dispensers). <br />'— <br />Double wall piping <br />or _ secondary containment (Trench liner, etc.) <br />X (1) <br />Product line (leak detector or automatic shut-off on <br />pressurized piping). <br />(2) <br />Vent and vapor recovery lines if not designed to <br />— <br />prevent the entrance of standing fluids. (Ball float valve) <br />X/ (3) <br />Manways and other single walled pipe fittings on a <br />double -walled tank, if not designed to prevent the <br />— <br />entrance of standing fluid. <br />State Vater Resources Control Board "Facility (A)n and "Tank Permit (B)" application forms submitted. <br />X Plan review and operating permit fees paid. <br />Monitoring and Response Plans submitted. <br />Proof of financial responsibility an file. <br />What is the approximate depth to ground water: <br />(include source of information - borehole logs, monitoring well data, water <br />studies, etc.) <br />Total number of tanks on site after installation: <br />Any existing tanks to be removed or abandoned? TES NO C ) If yes, submit State Water Resources <br />Control Board -Facility Permit (B)" application form. <br />Responsible party(fes) shall submit a `Letter of Comitmentm prior to the <br />= installation of new tanks. (Applies to sites with documented soil ani/or groundwater contamination) <br />County/City Fire District and Building Department notified. <br />REMARKS <br />------------------------------------------------------------------------------------------------------------------------- <br />------------------------------------------------------------------------------------------------------------------------- <br />------------------------------------------------------------------------------------------------------------------------- <br />--------------------------------- <br />7 <br />