BILLING 1986-1994 - Laserfiche WebLink

Home Browse Search

STATE OF CAUFORNA •�9O"- STATE WATER RESOURCES CONTROL BOARD • = coy; UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B "�� ; COMPLETE A SEPARATE FORM FOR EAC N K SYSTEM - ONLY ❑ 1 NEW PERMIT 3 gENEWAL PERMIT 5 CHANGE OF INFORMATICN YONE ITEM ❑ 2 INTERIM PERMIT 6 AMENDED PERMIT ❑ 7 PERMANENTLY CLOSED ONSITE ❑ e TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED /�[MARK BA OR FACILITY NAME WHERE TANK IS INSTALLED: S S �. �S I. TANK DESCRIPTION COMPLETE ALL ITEMS— SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# / B. MANUFACTURED BY: ul�� C. DATE INSTALLED(MOIDAYMEAR) D. TANK CAPACITY IN GALLONS: ILTANKCONTENTS IFA-1 ISMARKEO,COMPLETE REM C. p, ❑ 1 MOTOR VEHICLE FUEL ❑ 401OIL B. C. 18UNLGEAD 3 DIESEL ❑ e AVIATION GAS PETROLEUM ❑ B�EMPTY E2WASX7TE 1b PREMIUM 4 GASANOL 3 CHEMICAL PRODUCT ��—''�77/ UNLEADED O 5 JET FUEL ❑ 7 METHANOL 95 UNKNOWN 2 LEADED ❑ D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED 99 OTHER (DESCRIBE IN ITEM D. BELOW) C.A.S.#: III. TANK CONSTRUCTION MARK ONE'TEMONLY XESA BAND C.AND ALL THAT APPLIES IN BOX A. TYPED' ❑ 1 DOUSLE WALL 3 SINGLE WALL WITH EXTERIOR LINER SYSTEM ❑ ❑ 95 UNKNOWN ❑ 2 GLE WALL d SECONDARY CONTAINMENT (VAULTED TANK) ❑ W OTHER B. TANK 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD Wl FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OOTHERETHANOL COMPATIBLE W/FRP C.INTERIOR ❑ 1 RUBBER LVED ❑ 2 1) LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING LINING ❑ 5 GLASS LINING rL`,�/8 UNLINED ❑ 96 UNKNOWN ❑ W OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO_ D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 A3 VINYL TING ❑ PROTECTION E:] 5 CATHODIC PROTECTION 91 NONE ❑ 4 FIBERGLASS REINFORCED PLASTIC ❑95 UNKNOWN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IFABOVEGROONDOR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A GRAVI -` A U 99 OTHER B. CONSTRUCTION A U SING ALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A 95 UNKNOW U N A=U99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE PVC CORROSION A U 5 ALUMINUM ( )A U 4 FIBERGLASS PIPE A U 1 CONCRETE I U 7 STEEL96ZI OWING A U B 100% METHANOL COMPATIBLE WIFRP PROTECTION A U 9 GALVANIZED STEEL p U 10 CATHODIC PROTECTION p U N93�U IOGOWN � D. LEAK DETECTION ❑ LEAK DETECI AUTOMATIC LINE TOR A U 99 OTHER ❑ 2 LINE TIGHTNESS TESTING ❑ 31 STI ML V.TANK LEAK DETECTION MONIrORNG ❑ 90 OTHER ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPO ITORING❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING ❑ e TANK TESTING ❑ 7 INTERSTITIAL MONITORING NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAV/YR) 2.ESTIMATED OUANTITY OF y� SUBSTANCE REMAINING 3.WA5 TANK FILLED WITH GALLONS INERT MATERIAL? YES ❑ NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAME (PRINTED d SIGNATURE) DA S LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE F MBERS BELOW � C STATE I04OUNTY# JURISDICTION# FACILITY# TANK# (b US p`S PERMIT NUMBER PERMIT APPROVED BY/OATE / PERMIT EXPIRATION DATE FORM B (9.9q THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION RM A,UNLESS A CURRENT FORM A HAS BEEN FILED. WIgmIB.R1