Laserfiche WebLink
STATE,CF•-CALIFORI* WATER RESOURCES CONI .. BOARDS;. <br /> FORM B'' UNDERGROUND STORAGE TANK PROGRAM .yam <br /> TANK PERMIT AP •�/�� <br /> PLICATION INFORMATION <br /> TANK:;,' ,:..•,` COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. ` <br /> MARK ONLY 171 NEW PERMIT . 3 RENEWAL PERMIT Q 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED <br /> ONE ITEM Q 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED j <br /> FACILITY/SITE NAME WHERE TANK I8 INSTALLED: FARM TANK-YES❑ NO r <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY �% 2 C <br /> A. OWNERS TANK ID N B. MANUFACTURED BY: <br /> C. YEAR INSTALLED y y D. TANK CAPACITY IN GALLONS: <br /> 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. 1 MOTOR VEHICLE FUEL 2 PETROLEUM B. C. 1 UNLEADED LEADED 3 DIESEL <br /> 3 CHEMICAL PRODUCT 4 OIL 1 PRODUCT 4 GASAHOL 5 JET FUEL 6 AVIATION GAS <br /> L7 5 HAZARDOUS BO EMPTY [�] 95 UNKNOWN 2 WASTE 7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF I <br /> HAZARDOUS SUBSTANCE STORED&CA.S.N C.A.S.N: <br /> 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D <br /> A.TYPE OF L�tiT ABLE WALLED ❑ 3 SINGLE WAILED WITH EXTERIOR LINER 95 UNKNOWN <br /> SYSTEM E] 2 SINGLEWAILED 4 SECONDARY CONTAINMENT 99 OTHER <br /> . F7 1 STEEUIRON F7 2 STAINLESS STEEL F7 3 FIBERGLASS lk1 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B.TANK <br /> MATERIAL, 5 CONCRETE r7 6 POLYVINYL CHLORIDE F7 7 ALUMINUM 8 100%METHANOL COMPATIBLE FRP <br /> ❑ 9 BRONZE Q 10 GALVANIZED STEEL E 95 UNKNOWN 99 OTHER <br /> C. INTERIOR 1 RUBBER LINED 2 ALKYD LINING F7 3 EPDXY LINING 4 PHENOUC UNING <br /> LINING, ❑ 5 GLASS LINING 6 UNLINED 95 UNKNOWN / <br /> Q IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES L7 NO [:�99 OTHER <br /> D. CORROSION ❑IOLYETHLENE WRAP 2 TM OR ASPHALT 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION 5 CATHODIC PROTECTION 91 NONE 95 UNKNOWN 99 OTHER <br /> IV. PIPING INFORMAT N CIRCLE A IFABOVEGROUND, U IF UNDERGROUND.BOTH IF APPLICABLE <br /> A SYSTEM TYPE A .U 1 SUCTION A }V_2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> B. CONSTRUCTION A U 1 SINGLE WALLED A U DOUBLE WALLED A V 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEELIIRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A�U/�l FIBERGLASS PIPE A U 91 NONE <br /> C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAO W/FRP A Z] B 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER 1 <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> / P 8 1 VISUAL CHECK P 8 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS <br /> �j1G1/[�n P 86 PRECISION TESTING P 8 7 PRESSURE TESTING P 8 91 NONE P 8 95 UNKNOWN P 8 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF3.WAS TANK FILLED WITH <br /> OALLONi <br /> SUBSTANCE REMAINING IN INERT MATERIAL? YES D NO <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED&SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY Y JURISDICTION I AGENCY I FACILITY IDI TANK ID I <br /> CURRENT LOCAL AGENCY FACILITY ID 0 APPROVED BY NAME PHONE I WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> CHECK f PERMIT AMOUNT SURCHARGE AMT. FEE CODE 7CLiPT1 <br />• ,, FORM 8(6-29-88) THIS FORM MUST BE ACCOMPANIED 8Y A FACILITY/SITE APPLICATION, FO RM 'A',UNLESS A CURRENT FORMA' HAS Bf,[J Fu Fn <br />