BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

• P P�4n STATE OF CALIFORNIA • ` STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. F ❑ CHANGE OF INFORMATION 7 PERMANENTLY CLO N SITE 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CB TANK REMOVED © \p1 MARK ONLY ❑ ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE I%� ONE ITEM ❑ 2 INTERIM PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED; I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN B MANUFACTUPED BY: (( A.OWNER'S TANK 1.0.t a4A D. TANK CAPACITY IN GALLONS: C. DATE INSTALLED(MU AYNEAR) II.TANK CONTENTS IFA-115 MARKED,COMPLETE ITEM C. 1a REGULAR 3 DIESEL ❑ 6 AVIATIONGAS ❑ IL B. C. UNLEADED 4 GASAHOL 7 METHANOL A N1 MOTOR VEHICLE FUEL 4 O 1 PRODUCT lb PREMIUM ❑ O 2 PETROLEUM ❑ 80 EMPTY ❑ ❑ UNLEADED ❑ 5 JETFUEL 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) ED 3 CHEMICALPRODUCT 1:3 C.A.S. D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED III. TANK CONSTRUCTION MARK ONE ITEMONLY IN BOXES A.B,AND C.AND ALL THAT 3 SINGLE WALL WITH EXTERIOR LINER ES IN BO%D� 95 UNKNOWN A. TYPE OF ED1 DOUBLE WALL ❑ 99 OTHER 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ SYSTEM 2 SINGLE WALL 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W1 FIBERGLASS REINFORCED PLASTIC B. TANK ❑ 8 10M METHANOL COMPATIBLE W/FRP ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM MATERIAL ❑ 99 OTHER (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN E] 2 ALKYD LINING 3 EPDXY LINING ❑ 4 PHENOLIC LINING ❑ 1 RUBBER LINED ❑ g5 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 5 GLASS LINING 6 UNLINED LINING IS LINING MATERIAL COMPATIBL WITH 100% METHANOL? VES ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC D.CORROSION95 UNKNOWN E] 99 OTHER PROTECTION E] 5 CATHODIC PROTECTION 91 NONE ❑ INSTALLED(YEAR) E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U t BUD ION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U g9 OTHER U BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PI PE C. MATERIAL AND UM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W"P CORROSION A 5 ALUMINUM 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER PROTECTION A U 9 GALVANIZED STEEL A U 799 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ MONRORING ❑ V.TANK LEAK DETECTION GROUND ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING O 55 OTHER WATER MONITORING ❑ 6 TANK TESTING EO] 7 INTER //^^STITIAL MONITORING �1 NONE ❑ 95 UNKNOWN 99 VI.TANK CLOSURE INFORMATION 3.wps TANK FILLED WITH YES ❑ NOFV ESTIMATED QUANTITY OF GALLONS INERT MATERIAL? 1.ESTIMATED DATE LAST USED(MOIDAYNR) SUBSTANCE REMA NG 2. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF URY AND TO Y KNOWLEDDGEE IS T ^CORRECT JTHE BEST OF M APPLICANT ��v S NAME L�LUL (PRINTED 8 SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW TANK a C� JURISDURISD®p FACILITY3 I CAI STATE IDA PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE ENT FORMA HAS BEEN FILED. FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRFOR66413 R5 0 0