Laserfiche WebLink
STATE OF CALIFORN WATER RESOURCES CONT B <br /> FORM `8': OARD <br /> UN GROUND STORAGE TANK PR RAM <br /> TANK TANK PERMIT APPLICATION INFORMATION <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. e <br /> a <br /> C'kLikp NNA <br /> MARK ONLY 1 NEW PERMIT 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION <br /> ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 7 PERMANENTLY CLO K <br /> 6 TEMPORARY TANK CLOSURE 8 TANK REMOVEDEl <br /> 1 <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED;1906 0, 1 <br /> L TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY FARM TANK-YESE] NO <br /> FA. OWNERS TANK ID p 0 ACTURED INSTALLED ' <br /> al�T�ANCAPACITYIN GALLONS: 00 <br /> IL TANK LATENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. � <br /> A. EV 1 MOTOR VEHICLE FUEL 2 PETROLEUM <br /> 6, G. 1 UNLEADED 0 2 LEADED Chi <br /> 3 CHEMICAL PRODUCT 4 OIL DIESEL CID1 PRODUCT 4 GASAHOL 5 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS ❑ 60 EMPTY 0 95 UNKNOWN <br /> 2 WASTE 7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.Al <br /> C.A.S.p: <br /> -Ill. TANK CONSTRUCTION MARK ON ITEM ONLY IN BOX A,B,C,&D <br /> A.TYPE OF QUBLE WALLED 3 SINGLE WALLED WITH EXTERIOR LINER <br /> SYSTEM 95 UNKNOWN <br /> 251NGLEWALLED �4 SECDNOARYCDNTAINMENT <br /> 99 OTHER <br /> B.TANK STEELPRON 2 STAINLESS STEEL D 3 FIBERGLASS ❑ 4 STEEL CLAD W/PBFRGLASS REINFORCED PLASTIC <br /> MATERIAL ❑ 5 CONCRETE 6 POLYVINYLCHLORIDE 0 7 ALUMINUM 0 B 100%METHANOLCOMPATIBLEFRP <br /> 9 BRONZE 10 GALVANIZED STEEL Ej 95 UNKNOWN D 99 OTHER <br /> C. INTERIOR I RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING E] 4 PHENOLIC LINING <br /> LINING 5 GLASS LINING `UNLINED <br /> 0 95 UNKNOWN <br /> IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YE5 NO 99 dTHER <br /> D.CORROSION 1 POLYETHLENEWRAP TAR OR ASPHALT 0 3VINYL WRAP <br /> ,PROTECTION ❑4 FIBERGLASS REINFORCED PLASTIC <br /> 5 CATHODIC PROTECTION [:]91 NONE 0 95 UNKNOWN 99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE <br /> A U 3 GRAVITY A U 99 OTHER <br /> B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE <br /> C. MATERIAL A U S ALUMINUM A�Ua,6 CONCRETE <br /> A U 9 GALVANIZED STEEL A/11 J g5 UNKNOWN A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP <br /> CCU A U 99 OTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> r,l <br /> P S 1 VISUAL CHECK <br /> (!/ <br /> S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P S 7 PRESSURE TESTING <br /> P S 91 NONE R S 95 UNKNOWN P S 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATE DATE LAST USED(MO/YR) <br /> A 2. TI q ED QUANTITY OF <br /> 3•/�II CE REMAINING IN 3. WAS TA K L ED WITH <br /> GALLONS WE A7 L7 DYES F1 NO <br /> THIS ORM HAS BEEN COMPLETED UNDER PENAL OF PERJURY,AND To THE BEST OF MY KNOWLEDGE, 1S TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED&SIGNATURF( <br /> DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION# AGENCY# <br /> �--`-�--� FAC11 11 ILITY ID# TAMC ID# <br /> CURRENT LOCAL AGENCY FACILITY ID# O <br /> APPROVED N4/.E fPHONE#WITH AREA CODE <br /> PER NUMBER 6 <br /> PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> CHECK# PERMIT AMOUNT SURCHARGE AMT. <br /> FEE CODE RECEIPT# <br /> BY: <br /> FORM B(3-7-88) THIS FORM MUST BE ACCOMPANI Y A FACILITY/SITE APPLICATION, FORM 'A',UNLESSA�, RREN <br /> DATA PROCESSING COPY T FORMA' HAS BEEN FILEp <br />