BILLING_1985-2000 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL UNDERGROUND STORAGE TANK PERMIT APPLICATION -FORM B I COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY i NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSE �SI ONE REM 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 8 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.P NIA B. MANUFACTURED BY: Uk C. DATE INSTALLED(MO/DAY/YEAR) Uk D. TANK CAPACITY IN GALLONS: 400 II.TANK CONTENTS IF A-1 IS MARKED.COMPLETE ITEM C. A. M 1 MOTOR VEHICLE FUEL ❑ 4 OIL 8. O. fe REGUTA I UNLEADED 3 DIESEL O 8 AVIATION GAS ❑ 2 PETROLEUM ❑ 00 EMPTY 1 PRODUCT ❑ 1b PflEMNM UNLEADED 4 GASAHOL ❑ 7 METHANOL ❑ I9 MIDGRADE UN-EADED 5 JET FUEL ❑ B M85 ❑ 3 CHEMICAL PRODUCT ❑ BS UNKNOWN ❑ Z WASTE ® 2 LEADED g 99 OTHER(DESCRIBE IN ITEM D.BELOYA D. IF(A1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.4: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B,AND C.AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ❑ I DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 NTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM - ® 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK ® I BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ B POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP (PTIRIMY Tmk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ I RUBBER LINED O 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINTNO LINING OR ❑ 5 GLASS LINING En 8 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 107% METHANOL? YES_ NO— D.EXTERIORI POLYETHYLENE WRAP 2 COATING CORROSION ❑ ❑ ❑ 3 VINYL WRAP / FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODICPROTECTION ® Bt NONE El 95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL,BLC. SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) DROP TUBE YES_ NO STRIKER PLATE YES_ NO DISPENSER CONTAINMENT YES_ NO IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A(y 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A(4 I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND AQ 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 B CONCRETE A U 7 STEEL W/COATING A U 8 1)0% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION t "LCHAm uxE�"' 2 L91E MWK99 3 cartx WS Nrtm9 /ELEcma9c un9t 8 AlnouAnc EU1p ❑ 9E1E4TOR ❑ IE91N9 ❑ KON199m ❑ LM99 num ❑ SIMI09NN ❑ 99 OTHER NQnf V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 RECONCILIATIONANUAL INVENTORY ❑ 3 MONITORING ❑ 4 GAUGING IC TANK ❑ 5 MONITORINGTER ❑ 8 ANNUALTANK ❑ 7 CONTINUOUS MONITORING INTERSTITIAL ❑ 8 SIR ❑ B TANK lA MANUAL ❑10 MONTHLY TANK ® 95 UNKNOWN ❑99 OTHER VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PUCE) 1.ESTIMAIEO DATE LAST USED(MOIDAY/YR) 2.ESTIMATED QUANTITY OF ZOO 3.WASTAT(FILLED WITH YES ❑ NO UK SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNER'S NAME ]J, ing'2Inc. y or e on rao or DATE9 (PAWED A BKWATURE) LOCAL AGENCY USE 0 Y THE STATE I.D.K BER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY N JURISDICTION I FACILITY A' TANK A OC)10 STATE I.D:N m m� KE IMI PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLIC FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FO UST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLALE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UgWROUND STORAGE TANK REGULATIONS FORM 0 (8-95)