Laserfiche WebLink
STATE OF CALIFORNI& WATER RESOURCES CONTRIJBOARD <br /> FORM `B': UND GROUND STORAGE TANK PR RAM <br /> TANK PERMIT APPLICATION INFORMATION <br /> TANK COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. <br /> 5 CHANGE OF INFORMATION El 7 PERMANENTLY CLOSED TANK <br /> MARK ONLY ❑ 1 NEW PERMIT F-13 RENEWAL PERMIT �.. <br /> ONE ITEM El 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED - <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: <br /> N� FARM TANK-YES NO <br /> -------------- <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS IF UNKNOWN-ISO SPECIFY <br /> B. MANUFACTURED BY: <br /> EC. <br /> WNERS TANK ID# <br /> D. TANK CAPACITY IN GALLONS: <br /> EAR INSTALLED <br /> II. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.!IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. 0 1 MOTOR VEHICLE FUEL F-1 2 PETROLEUM <br /> B C. 1 UNLEADED 2 LEADED 3 DIESEL <br /> 3 CHEMICAL PRODUCT F-1 4 OIL <br /> 1 PRODUCT ❑ 4 GASAHOL 5 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS Ej 80 EMPTY E] 95 UNKNOWN 2 WASTE 0 7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.It: <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.If <br /> III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D <br /> A.TYPE OF ❑ 1 DOUBLE WALLED F_�3 SINGLE WALLED WITH EXTERIOR LINER 95 UNKNOWN <br /> SYSTEM F� 2 SINGLE WALLED 0 4 SECONDARY CONTAINMENT <br /> 99 OTHER <br /> Q 1 STEEL/IRON F-1 2 STAINLESS STEEL F-1 3 FIBERGLASS 4 STEEL CLADW/FIBERGLASS REINFORCED PLASTIC <br /> B.TANK F] 5 CONCRETE 6 POLYVINYL CHLORIDE F-1 7 ALUMINUM 8 100%METHANOL COMPATIBLE FRP <br /> MATERIAL ❑9 BRONZE 10 GALVANIZED STEEL D 95 UNKNOWN 99 OTHER <br /> Q 1 RUBBER LINED F-I 2 ALKYD LINING 0 3 EPDXY LINING El 4 PHENOLIC LINING <br /> C. INTERIOR Q 5 GLASS LINING El 6 UNLINED 0 95 UNKNOWN <br /> LINING <br /> IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL9 0 YES 0 NO 0 99 OTHER <br /> D.CORROSION ❑ 1 POLYETHLENE WRAP F-12 TAR OR ASPHALT 0 3 VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION F-] 5 CATHODIC PROTECTION [] 91 NONE 0 95 UNKNOWN 0 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 95 UNKNOWN A U 99 OTHER <br /> A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U <br /> B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> U 4 FIBERGLASS PIPE A U 91 NONE <br /> A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A <br /> C.MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,ORI S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> P S 1 VISUAL CHECK P S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 99GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN <br /> OTHER <br /> V1. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE �3WA TANK FILLED WITH1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF T MATERIAL? YES�ENO <br /> SUBSTANCE REMAINING IN GALLONS <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> DATE <br /> APPLICANT'S NAME(PRINTED&SIGNATURE) <br /> LOCAL AGENCY USE ONLY <br /> FACILITY ID# TANK ID# <br /> [PERMIT <br /> ENR'SDICTION# AGENCY# / <br /> ITY ID# <br /> APPROVED BY NAME PHONE#WITH AREA CODE <br /> PERMIT APPR VAL DATE PERMIT EXPIRATION DATE <br /> FEE CODE ECEIPT# BYj�iMOUNT SURCHARGE AMT. Cr'^ <br /> FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE APPLICATION, FORM `A',UNLESS A CURRENT FORMA' HAS BEEN FILED r <br /> DATA PROCESSING COPY <br />