BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA -... STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM A. OWNER'S TANK I. D.s B. MANUFACTURED BY: C. DATE 91S ALLED(MO/DAY/YEAR) 0, TANK CAPACITY IN GALLONS: VU I. TANKtONTENTS IFA.IICMSRKFn( PIFTFITFMC A 1 MOTOR VEHICLE FUEL ❑ 6 OIL B. C Ia REGUUR UNLEADED 3 DIESEL 8 AVIATION GAS ❑ 2 PETROLEUM ❑ W EMPTY 1 PROOl1CT ❑ 19UNlEAOED s GASAHOL ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 5 JE T FUEL ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER A U ❑1 RUBBER LINED 9D OTHER (DESCRIBE IN ITEM D. BELOW) 0. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED 5 GLASS LINING F7V C. A. S. s : C::] OTHER III. TANK CONSTRUCTION MARK Mg RFU nNI Y IN 97IKPS A R sunt unAll TYAT APR. ICC IM.It I A. TYPE OF❑T'�)(/ /_'DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN SYSTEM I.CJ C INGLE WALL ❑ l SECONDARY CONTAINMENT (VAULTED TANIQ ❑ 99 OTHER 8. TANK t BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CUD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP (Primary TARk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER A U ❑1 RUBBER LINED ❑ 2 ALKYD LWWO❑ 3 OX LINING ❑ 6 PHENOLIC LINING C. INTERIOR LINING 5 GLASS LINING F7V ❑ 8 UNLINED 95 UNKNOWN99 C::] OTHER A U IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO 7 STEEL W/COATING D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 INYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ILKNUNKNOWN ❑ 99 OTHER PIPING INFORMATION (r�IV. t1 1 SUCTION AU B 3 GRAVITY A U CIWN9 A IFAAOVPrImmiNn OR ll w iim MOtsu encu seep i—ac . SYSTEM TYPE A U 1 SUCTION AU 2 PRESSURE A U 3 GRAVITY A U 99 OTHER . CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U K FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEEL W/COATING A U 8 100% 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 ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ T MONRORWGL ❑ OTHER K LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING ❑ A AUTOMATIC TANK GANGING ❑ 5 GROUND WATER MONITORING ❑ 8 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER L ESTIMATED DATE UST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES [:] NO ❑ 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 APPLICANTS NAME DATE IGPINTER65K.NANREI1 -7 LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW / 4v1244v124 COUNTY s JURISDICTION 9 FACILITY 9 TANK a STATE I.D.# M 'ERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE )RM a (9-9ol THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION • FORM A. UNLESS A CURRENT FORM A HAS BEEN FILED