WORK PLANS - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA WATER RESOURCES CONTRO""pARD ? FORM 'B': UNDEI(GROUND STORAGE TANK PROMAM TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. 10 MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 MANENTLY CLqSEDJjNK ONE ITEM ❑ 2 INTERIM PERMIT ❑4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE B TANK REMOVED N FACILITY/SITE NAME WHERE TANK IS INSTALLED: QS v-yF q„ ' X1 j Q A/ FARM TANK-_USE:] N jb► I. TANK DESCRIPTION OMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY c" A. OWNERS TANK IDp / 8. MANUFACTURED BY. W C. YEAR INSTALLED �G D. TANK CAPACITY IN GALLONS: Z II. TANK 96NTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A 1 ,IS NOT MARKED,COMPLETE ITEM D. A. 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUMC. ❑ 1 UNLEADED LEADED ❑3 DIESEL F-13 CHEMICAL PRODUCT F—] B 4 OIL /, PRODUCT ❑ 4 GASAHOL ❑ 5 JET FUEL ❑6 AVIATION GAS ❑ 5 HAZARDOUS ❑ BO EMPTY ❑95 UNKNOWN ❑ 2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN REM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED 8 CAS.A C.A.S.M: 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,8,C,A O A TYPE OF ❑ I BLE WALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ZLE WALLED ❑4 SECONDARY CONTAINMENT ❑ 99 OTHER llf I STEELARON ❑2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B.TANK ❑ 5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑ 7 ALUMINUM B 100%METHANOL COMPATIBLE FRP MATERIAL ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER F—] 1 RUBBER UNED ❑2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 P ENOUC LINING C.INTERIOR LINING F-15 GLASS LINING ❑6 UNLINED OWN ❑ IS LINING MATERIAL COMPATIBLE WITH IOD%METHANOL? ❑YES NO OTHER D. CORROSION ❑ 1 POLYETHLENE WRAP ❑2 TARORASPHALTk95 WRAP4 FIBERGLASS REINFORCED PLASTICPROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE UNKNOWN 99 OTHER IV. PIPING INFORMA N CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 9 NKNOWN A U 99 OTHER B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A NKNOWN A U 99 OTHER A UI STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C.MATERIAL A U 5 ALUMINUM AV= A U 7 STEEL CLAD W/FRP A U 8 109%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL 5 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 VISUAL CHECK P 3 2 INVENTORY RECONCILIATION P8 3 VADOSE WELLS ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS P 8 6 PRECISION TESTING P S 7 PRESSURE TESTING P 8 91 NONE P 8 5 UNKNOWN P 8 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? EDYES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. APPLICANT'S NAME(PRINTED&SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY M JURISDICTION R AGENCY R FACILITY ID R TANK ID R ® E= lo00 CURRENT LOCAL AGENCY FACILITYpIDI rAnno 0 APPROVED BY NAME PHONE I WITH AREA CODE PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE i CNECKI PERMIT AMOUNT SURCHARGE AMT. FEE CODE ECEIPTI BY: ( 1 FORM B(6-29.88) THIS FORM MUST BE ACCOMPANIED BY A FACILRY/SITE APPLICATION, FOR M 'A',UNLESS A CURRENT FORMA HAS BEE FILE