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INSTRUMONS FOR COMPLETING B. <br /> GENERAL IN,S`l'RUCTIONS. <br /> 1. One FORM"B"shall be completed for each tank for all NFW PF,RMrTS,PERMIT CHANG30% REMOVAI.S and/or any <br /> other TANK INFORMATION CHANGE <br /> 2. This form should be completed by either the PFRMIC APPLICANT or the LOCAL AGENCY UNDERGROUND TANK <br /> INSPECTOR <br /> 3. Please type or print clearly all requested information. <br /> 4. Use a hard point writing instrument,you are making 3-copies. <br /> TOP OF FORM *NCARK ONLY ONE <br /> 11. Mark an (X) in the box next to the item that best describes the reason the form is being completed. <br /> 2. Indicate the DBA or Facility name where the tank is installed. <br /> I. 'TANK DFSC.'RIPTION-COMPLUM,ALL r17MS-H`UNKNOWN-SO SPECIFY <br /> A. Indicate owners tank ID#-If there is a tank number that is used by the owner to identify the tank(ex.AB70789). <br /> B. Indicate the name of the company that manufactured the tank (ex.ACME'TANK MFG.). <br /> C. Indicate the year the tank was installed(ex. 1987). <br /> I). Indicate the tank capacity in gallons(ex.25,000 or 10,000 etc.). <br /> H. TANK CONTENTS <br /> A. 1. If MOTOR VEHICLE FUEL,check box 1 and complete items B&C. <br /> 2.If not MOTOR VEHICLE FUEL,check the appropriate box in section A and complete items B& D. <br /> B. Check the appropriate box. <br /> C. Check the type of MO'T'OR VEEIICLE FUEL(if box 1 is checked in A). <br /> D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#.(Chemical Abstract Service <br /> number),if box I. is NOT checked in A. <br /> M. TANK CONSTRUCTION-MARK ONE r173M ONLY IN BOX A,B,C&D <br /> 1. Check only one item in TYPE OF SYSTEM,'TANK NINFERI.AI.., INTERIOR LINING and CORROSION PROTECTION. <br /> 2. If OTHEIZ,print in the space provided. <br /> IV. PIPING INFORMATION <br /> 1. Circle A if above ground; circle U if underground;and circle both if applicable. <br /> 2. If UNKNOWN,circle; or if 017IE13print in space provided. <br /> 3. Indicate the LEAK DE17 C"TION system(s)used to comply with the monitoring requirement for the piping. <br /> V. TANK LEAK DF,WCUON <br /> 1. Indicate the I.,EAK DETECI7ON system(s) used to comply with the monitoring requirements for the tank. <br /> VL INFORMATION ON TANK PERMANFNI7:Y CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED-MONTH/YEAR(January, 1988 or 01/88). <br /> 2. ESTIMA 111)QUAiN'TII:Y of HAZARDOUS SUB51'ANCE remaining in the tank(in Gallons). <br /> 3. WAS'TANK FILLED WITH INERT"MATERIAL? Check'Yes'or:NO'. <br /> APPLICANT MUST SIGN AND DATE'TIIE FORM AS INDIC NIF.D. <br /> IN UC17ON FOR"CITE LOCAL.AGENCIES <br /> The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction <br /> number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and <br /> can be obtained by calling the State Board(916)739-2421. The facility number must be the same as shown in form "A". The <br /> tank number may be assigned by the local agency; however,this number must be numerical and cannot contain an alphabet. If <br /> the local agency prefers the State Board to assign the tank number,please leave it blank. <br /> ri'IS THF,RESPONSIBH1I'Y OF THE LCH'..AL AGENCY THAI'INSPECTS T1IE FA(.IITI'Y'T'O VERIFY THE <br /> ACCURACY OF TIH!INFORMATION. 171E LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF'I7111 <br /> 'LOCAL AGENCY USE ONLY'INFORMATION BOX AND FOR FORWARDING ONE FORM'A'AND ASSOCIATED <br /> FORM'B'(s)TO TIW,FOLLOWING ADDRESS. <br /> SrA17?OF CALIFORNIA <br /> STATE WA173K RESOURCES CONTROL BOARD <br /> C/O S.W.E.F P.S. <br /> DATA PROCESSING C.FNITR <br /> P.O.BOX 527 <br /> PARAMOUNT,CA 90723 <br />