BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

TANK TANK "ERMITAPPLICATION INFORMP`ON ,o COMPLETE ..... 'E FORM WITH THE FOLLOWING I ORMATTQ,,OR EACH TANK. .� [M:A:RK 5 ONLY ❑ 1 NEW PERMIT ❑ O RENEWAL PERMIT CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED TANK TEM E012 INTERIM PERMIT ❑ A AMENDEDPERMIT ❑6 TEMPORARY TANK CLOSURE ❑ 6 TANK REMOVED FACILITY/SITE NAME WHERE TANK IS INSTALLED; ] S 6 0? UlAd5A4AtAJ JfJFARM TANK - YES ❑ NO I. TANKDESCRIPTION COMPLETE ALL ITEMS -IF UNKNOWN—SO SPECIFY J A. OWNERS TANK IDN 14 -T B. MANUFACTURED BY: C. YEAR INSTALLED 7 D. TANK CAPACITY IN GALLONS: W o 11. TANK ObNTENTS mFAit....... K.IYIIe11.4 ETE ITEM D. A_ I MOTOR VEHICLE FUEL ❑ 2 PETROLEUM S. C. I (UNLEADED ❑ 2 LEADED ❑ O DIESEL ❑ O CHEMICAL PRODUCT ❑ 1 OIL I PRODUCT ❑ A GASAHOL ❑ 5 JET FUEL ❑ 6 AVIATION GAS ❑ 5 HAZARDOUS ❑ 80 EMPTY E]95 UNKNOWN ❑ 2 WASTE ❑ 7 METHANOL ❑ 99 OTHER (DESCRIBE IN ITEM D , BELOW) O. IF NOT MOTOR VEHICLE UEL, ENTER NAME OF F ❑ I SECONDARYCONTAINLENT HAZARDOUS SUBSTANCE STORED A C.AS. M B. TANK ❑ 1 STEELIMON C.A.S. M. .111 TAMC!`nucrn..nr..... ❑ 1 STEEL CLAD WIFIBERaM REINFORCED PLASTIC A TYPE OF ❑ 1 DOUBLE WALLED ❑ 7 SINGLE WALLED WITH EXTEROR LINER �. _ _ ❑ % UNKNOWN SYSTEM ❑ 2 SINGLE WALLED ❑ I SECONDARYCONTAINLENT ❑ 99 OTHER B. TANK ❑ 1 STEELIMON ❑ 2 STAINLESSSTEEL ❑ J FIBERGLASS ❑ 1 STEEL CLAD WIFIBERaM REINFORCED PLASTIC MATERIAL ❑ 5 CO4OE7E ❑ 6 POLYVIWL CHLORIDE ❑ 7 ALUMINUM ❑ I IBB%WDMNOL COMPATIBLE FW ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTTER C. INTERIOR ❑ I RIBBER UNED ❑ 2 ALKYD LNING ❑ 7 EPDXY LINING ❑ 1 PHENOLIC DING LINING ❑ 5 GLASSLMNG ❑ 6 UNUNED I ❑ % UNKNOWN 9 POLYVINYL CHLORIDE(PVCB ❑ IS UNING MATERIAL COMPATIBLE WITH IW%METHANOLT ❑ YES ❑ NO ❑ 99 OTHER D. CORROSION ❑ I POLYETHLENE WRAP ❑ 2 TAR OR ASPHALT ❑ S VINYL WRAP ❑ A FIBERGLASS REINFORCED NASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑ % UNKNOWN ❑ 99 OTHER IV. PIPING INFnAUATlnu V. A SYSTEM TYPE A U I SUCTION A U 2 PRESSURE A U B GRAVITY ••• •• ^`A`•U ^N B. CONSTRUCTION A U I SINGLE WALLED A U 2 DOUBLE WALLED A U B LINED TRENCH OTHER PERMIT EXPIRATION DATE A U 95 UNKNOWN A U 99 OTHER C. MATERIAL A U I STEEVIRON A U 2 STAINLESS STEEL A U 9 POLYVINYL CHLORIDE(PVCB A U A FISERGLASSPIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CUD W/FRP A U S IRB% METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U N OTHER ^•• ..�. L\.I IVIY a T a 1 CM CIRCLE P FOR PRIMARY.OR S FOR SECONDARY A PRIMARY I FAV ncrcran.. e..��.. ......�.. ----- ..v......... .... .c YINVLC V. P S I VISUAL CHECK P S 2 INVENTORYRECONCILIATION P S 9 VADOSE WELLS P S I ELECTRONIC MONITOR P S 5 GROUNDWATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S N OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE I ESTIMATED DATE LAST USED IMO/YRI 2 ESTIMATED OUANTITY OF SUBSTANCE REMAINING IN ] WAS TANK FILLED WITH GALLONS INERT MATERIAL"+ YES ❑ NO] _ THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PFRII B7V Aran Tn Tur .cll nr 1... ,..,,.,.,. ---- .,......_ ..._ _ _ LOCAL A(' _ -.._ . _ ..._ ..�... ... .... .a •v..Lcvlaq IS . nuc AND CC) APPLICANT'S NAME (PRINTED 6 SIGNATURE; Dq F T VOC WNLI RRECT COUNTY E JURISDICTION R AGENCY M FACILITY ID E EIIZZYM TANK ID R Irl CURRENT LOCAL AGENCY FACILITY IO • APPROVED BY NAM PHONE P WITH AREA CODE PERMIT NUYBER PERMT APPROVAL DATE PERMIT EXPIRATION DATE G // CHECK c IERYIT wYOUNT BURCNARGE AMT. FEE COPE BE"#"c T— BY. ORM R 0 7 -IBI THIS FORM MUST BE ACCOMPANIED BY A FACILITYISITE APPLICATION. DATA PROCESSING COPY 7 10 A N N