BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

i SPATE OF CAUFORMA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B, COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE '❑ 6 TANK REMOVED ONE REM ED 2 INTERIM PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: S ,Vv ly . I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. C.� B. MANUFACTURED BY: L C. DATE INSTALLED(MO/DAYNEAR) -7,1 I D. TANK CAPACITY IN GALLONS: r LETE REM C ILTANKCONTENIQ IFA-11SMARKED.COMP e�� MOTOR VEHICLE FUEL ❑ 4 OIL B. 3 DIESEL❑ 6 AVIATION GAS Q 1iUNGEADED A. O7 2 PETROLEUM ❑ 80 EMPTY ❑ 1 PRODUCT A GASAHOL METHANOL ❑ 1b PREMIUUNLEADED ❑ 5 JET FUEL ❑ ❑ 3 CHEMICALPRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE I ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C. A. S. s III. IAlyn I vllry Inu�,.V"—,-1.1.--1.1�.^ ^.-•._.__.. _._..__.. A� PRESSURE A U 3 GRAVITY A U 99 OTHER 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN A. TYPE OF SYSTEM pp❑� g_7-2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER MATERIAL AND t BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CUD W/ FIBERGLASS REINFORCED PLASTIC B. TANK ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 6 100'% METHANOL COMPATIBLE W/FRP MATERIAL (PrimaryTank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER A U 10 CATHODIC PROTECTION ❑ t RUBBER LINED 2 ALKYD LWNG ❑ 3 EPDXY LINING ❑ d PHENOLIC LINING C. INTERIOR ❑ 5 GLASS LINING �6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH tOD%MEl}IANOL? YES_ NO_ ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC D. CORROSION PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) lif niniki `Ia IIfn0RAAnMkI 111C u1d1Wf.ChI IMr1 P(ITL6 aPPI MCRIF A. SYSTEM TYPE A U 1 SUCTION A� PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION Ad�? SINGLE WALL A U 2 DOUBLE WALL A U 3 LINO TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL Wt COATING A U B 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A l�b UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING El0 MONITORING ❑ 99 OTHER v TANK I FAK IIFTFT 10N ❑ _.. 1 VISUAL CHECK INVENTORY RECONCILIATION ❑ 3 VADDIE MONITORING ❑ d AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING ❑ 6 TANK TESTING ❑ 7 INTERSTITIALMONUORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER INFORMATION 1. ESTIMATED DfTTE LAST U57(MO/DAY/YR) I 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES ❑ NO ❑ /w- /��—�_/ SUBSTANCE REMAINING _GALLONS INERTMATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT PPLICANTS NAME DATE IRIWED 6 SIGNAWFIEI ,r)C:AI AG FNCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D. m PERMITNUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORMS (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILEU. • 0 FOR0=84RS