BILLING 1986 - 1992 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORN16 WATER RESOURCES CONTROOARD FORM 'B': UNDERGROUND STORAGE TANK PROGRAM TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWINO INFORMATION FOR EACH TANK. MARK ONLY ❑ I NEW PERMIT ❑3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑7 PERMANENTLY CLOSED TANK 10 ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ❑6 TANK REMOVED 6- p FARMTANK-YES❑ NO ❑ N FACILITY/SITE NAME WHERE TANK IS INSTALLED: V I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY W A. OWNERS TA IDN O-31 B. MANUFACTURED BY: C. YEAR INSTA LED D. TANK CAPACITY IN GALLONS: Q� II. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A. 1 MOT RVEHICLE FUEL ❑ 2 PETROLEUM B. C. ❑ 1 UNLEADED ❑ 2 LEADED 3 DIESEL ❑3 CHEN ICAL PRODUCT ❑ 4 OIL PRODUCT ❑4 GASAHOL ❑5 JET FUEL ❑6 AVIATION GAS ❑ 5 HAD RDOUS E] 80 EMPTY E]95 UNKNOWN ❑ 2 WASTE ❑T METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM D,BELOW) D. IF NOT MIDI OR VEHICLE FUEL,ENTER NAME OF C.A.S.#: HAZARDOU SUBSTANCE STORED&C.A.S.# III. TANK CO 4STRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D A. TYPE OF ❑ 1 DOUBLEWALLED ❑ 3 SINGLE WALLED WITH EXIERIORLINER 95 UNKNOWN SYSTEM ❑2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER 15TEELIIRON ❑25TAINLE55 STEEL ❑ 3RBERGLASS ❑4STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B.TANK ❑ 5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑7 ALUMINUM ❑6100%METHANOL COMPATIBLE FRP MATERIAL ❑9 BRONZE ❑ 10 GALVANIZED STEEL ❑95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER UNED ❑ 2 ALKYD LINING ❑ 3 EPDXY LININGn('PHENOLIC LINING C LINING INTERIOR F-15 GLASS UNING F-16 UNLINED 95 UNKNOWN ❑IS LINING MATERIAL COMPATIBLE WIT 10096METHANOL9 ❑YES ❑ NO ❑99 OTHER D. CORROSION F] 1 POLYETHLENE WRAP 2TAR OR ASPHALT ❑3VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑91 NONE ❑95 UNKNOWN ❑ 99 OTHER IV. PIPING INFORMAT N CIRCLE A IFABOVEGROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE U SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B.CONSTRUOTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE 5 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYLCHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELCLADW/FRP A U B 10D%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A 9 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. / P S 1 VISUA-CHECK 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUNDWATER MONITORING WELLS /} P S 6 PRECISION TESTING P S 7 PRESSURETESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER �i- VI. INFORM TION ON TANK PERMANENTLY CLOSED IN PLACE 2. 3.WAS TANK FILLED WITH ESTIMATED QUANTITY OF 1. ESTIMAT DATE LAST USED(MO/YR) SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? ❑YES ❑ NO THIS F RM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. DATE APPLICANT'S NAME(PRINTED&SIGNATURE) LOCAL AGENCY USE ONLY COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# l FCHECK* LOCAL AGENCY FACILITY ID# APPROVED BV NAME PHONE#WITH AREA CODE 21211,70 gAt7oUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE BY:p PERMIT AMOUNT SURCHARGE AMT. FEE CODE ECEIPT# f LL FORM B(6-29-9B) THIS FORM MUST BE ACCOMPANIED BY A FACILITYISITE DATA PPR TION, NOGRMOA',UNLESS A CURRENT FORMA' HAS BEEN FILED