WORK PLANS - Laserfiche WebLink

Home Browse Search

C��V CnZ STATE OF CALIFUMA STATE WATER RESOURCES CONTROL BOARD / UNOERGROU"O STORAGE TANK PERMIT APPLICATIW. FOAM B a COMPLETE A SEPARATE FORM FOR H TANK SYSTEM. / `�.�•-' MARK ONLY Q 1 NEW PERMIT a 3 AGNEWAL PERMIT S CHANGE OF INFORMATION 7 PERMANENTLY - N�Ir ONE REM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ e TEMPORARY TANK CLOSUR15 TANx Rt�10YE O DBA OR FACILICY NAME WHERt:^TdF1)NS INSTALLED- z!i � 0- L �3 \ / L TANK 0 ESCRIPTION j COMPLETE ALL ITEMS- SP£CSFY IF uwNOWN A. OWNER'S TANK L O.s 1 B. MANUFACTURED 8Y: G GATE INSTALLED(MGOAY )l 0. TANK CAPACITY IN GALLONS llC Q—v—� J1 II.TANK C ENTS IFA.IISMARKED,COMPLETE mew c. 1 / I MOTOR VEHICLE FUEL ❑ t OIL g. C 1-1 7a RUNEGULAALEACED ! ] �D�IESEL a R AYtATIGv GAS ❑ 2 PETROLEUM C::] 80 EMPTY I PRODUCT ,�❑ IbP MIUM 7 METHANOL ❑ 3 CHEM AL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE 2 LEAQEA:0 D 5 lETFUEL 99 OTHER MESCMIF IN ITEM 0. BELOV11 D. IF(0.t)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED. C.A.S.s III. TANK CONSTRUCTION MARK ONE REM ONLY IN QOXES A.a.ANO C.AND ALL THAT APPLIES tN BOX D A. TYPE OF ❑ i DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERKOR LINEA 95 UNKNOWN SYSTEM U2 SINGLE WALL ❑ A SECONDARY CCNTAKNMENT (VAULTED TANK) ❑ 99 OTHER ❑ B. TANK 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 F18ERGLLSS ❑ A STEEL CLAD Wl FIQEAGLASS AEINFOAcao PLASTIC MATERIAL ❑ 5 CONCRETE ❑ e POLYVINYL CHLORIDE ❑ 7 1JMINUM ❑ 8 tCCW- M014ANOL gMPATIBLE W/FRP (FrimaryTMnc) ❑ 9 SRONZE Q 10 GALVAN&MO STEEL os Umc4owN ❑ 99 OTHER ❑ t RUBBER LINED Q 2 ALKYO LINING ❑ 3,006y LINING ❑ A PHENOLIC LINING C.INTERIORUN NG ❑ 5 GLASS LINING a e UNLINED 8e UNMOWN 99 OTHER IS LINING MATERIAL. COMPATIBLE WITH 10Cx METHANOL? YES_ NO— D.CORROSICN ❑ 1 POLYEi}dY1 WRAP a 2 COATING ❑ 3 VINYL WRAP ❑ A FIBERGLASS REINFORCED PLASTIC PROTECTION a 5 CATHCDIC PROTECTION a 91 NCNE ❑ 95 UNKNOWN ❑ 99 OTHr:a IV.PIPING INFORMATION CKRCL.E A IFASOVEGRCUNOOR U IFUNCEAGROUN0.30THIFAPPL[CABLE A. SYSTEM TYPE A U I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRFINCH A U 95 UN104OWN A U 99 OTHER C. MATERIAL AND A U I BASE STEEL A U 2 STAINLESS SieEL A U 3 POLYVINYL C14LOAlCE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U a CCNCRETE A U 7 STEEL VWCOATWG PROTECTION A U 9 GALVANIZED STEFL, A U 10 CAT14CO�CPROTECTICN A U 1007. METHANOL gMPATIQLEWrFRp 9 A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ t AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3:v uL 99 OTHER LCNrIORMG ❑ V.TANK LEAK DETECTION c t VISUAL CHECK 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONPTORING A AUTOMATIC TANK GAUGING❑ 5 GROUND WAicR MCNt'i CRtNG 5 TANK TESTING a 7 WTERSTRIAI.MONKTORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION t.ESTGIATED DATE LAST USED(MOoDAYrYR) 2.ESTIMATED CUANTTTY OF I 3.WAS TANK FB.LED WKT}4 SUBSTANCEAEMAWING GALLONS WERTteAT'eRIAL7 YES ❑ NO❑ THIS FORM HAS SEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT APPUCANrs NAME IPwr.M A SrGMTURIn DATE LOCAL AGENCY USE ONLY THE STATE LD.NUMBER LS COMPOSED OF THE FOUR NUMBERS BELOW G� J AUNTY 4 JURISDICTION s FACILITY 9 'TANKC s STATE Ll).� 3 p l V OI. b vP p r PE±+MIT NUIMBEA PERMIT-APPROVED SY/OATE PERMIT EXPIRATION ATE ' FORM 0 (9-90 THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORMA.UNLESS A CURRENT FOAM A HAS BEEN FILED. ; FOAoaK+& - f Y • E s