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<br /> INSTRUCTIONS FOR COMP11MIiNG Tk)RM'I3”
<br /> GENERAL INSTRUCI.IONS:
<br /> L One FORM "B"shall be completed for each tank for all NEW PERMH'S,PF.RMri'('TIAi+�GES,
<br /> other TANK INFORMATION CEIANGR
<br /> 2. This form s;toutd be completed by either the PERMIT APPI.,ICANT or the LOCAL AGENCY UNDERGRt:,WIND TANK
<br /> 3. Please t,-I, c r print clearly all requested information,
<br /> 4. Use a 35aru point writing instrument,You are making 3 copies.
<br /> TOP Oil FORM:"MARK ONLY ONE rI13M"
<br /> 1. Mark an (X)in the box next to the item that best describes the reason the form is being completed.
<br /> 2. Indicate the IBA or Facility name where the tank is installed.
<br /> I. TANK DESCRIPTION-COMPTI?'I71 All,MI NS-IF UNKNOWN-SO SPI;�G'IFY
<br /> A. Indicate owners tank Ill # -If there is a tank number that is used by the owner to identify the tank(ex.AB707S9).
<br /> B. Indicate the name of the company that manufactured the sank(ex.ACME?TANK MFG.).
<br /> C. Indicate the vear the tank was installed (ex. 1.987).
<br /> 1). Indicate the tank capacity in gallons(ex.25,000 or 10,000 etc.).
<br /> H. TANK CON'IIUVI')
<br /> A. 1, If MO'1. ,*R VEI IICLE FUEL.,check box 1 and complete items B &C,
<br /> 2. If not _`,ROTOR VI FIICLE FU'EL.,check the appropriate box in section A and complete items B& I7,
<br /> B. Check the appropriate box.
<br /> C. Check the type of MOTOR VEHICLE FUEL,(if box 1 is checked in A).
<br /> 1). Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service
<br /> number), if box 1 is NOT checked in A.
<br /> III_ TANK CONSIRUC.:IION-MARK ONB rnw. ONLY IN BOX A,B,C&D
<br /> 1. Check only one item in'TYPE OF S'YSTL4I,'PANIC MATERIAL,]IN'T'ERIOR LINING and COTZROSION 1'SCC)ITCTI(:N,
<br /> 2. If 017IIE R,print in the space provided.
<br /> IV. PIPING;INFORMWITON
<br /> 1. Circle A if above ground,circle II if underground; and circle both if applicable.
<br /> 2. If. UNKN T(.)WN,circle or if OL'IJER.print in space provided,
<br /> 3. Indicate the LIZe\K D J1(','7:'IO'N systcm(s)used to comply with the monitoring requirement for the pissing,
<br /> V 'TANK LPAK DUIT"ION
<br /> 1. Indicate the I,FAK 1)F:aIF'sC;,PION systems) used to compiv with the monitoring requirements for the tank.
<br /> VI, INFORMA7I1ON OSI TANK PI:RMANI N I'LY C.1,OS1,D IN PI.ACI3
<br /> 1. F::Sn,%1A'!TD DNFE L,A51'USED- MON'I'll/YL R(.Ianuan, 1988 or 01/189).
<br /> 2. PSHMA)'ED QUAtiII'I:'Y of IIA/ARDOUS SUBSTANCE remaining in the tank (in Gallons).
<br /> 3. WAS TANK FILLED WFIII INERT'MA'JURIAL? Check'Yes'or*NO'.
<br /> APPLICANT MUSI'SIGN AND DA`I73'I.1II3 FORM AS TNI)IC'AaT7:iI).
<br /> INSI'RUCIION FOR'11111,LOCAL AGINC7I:S
<br /> The state undergrenutd 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. 7,'he county and jurisdiction numbers are predetertnilled and
<br /> can be obtained by calling the:State Board (916)739-2421. The facility number must be the santeas shown in ftsTrn A". 'I,'he
<br /> tank number may be assigned by the local agency, however,this number must be numerical and cannot contain as alphabet. If
<br /> the local agency prefers the State Board to assign the tank number, pleas:leave it blank.
<br /> rI'IS'I11E RF-SPONSIBIIXIN OF"IMF LOCAL AGI:rNC:Y TI IAT INSPF,C-IS TI IF3 FACILTI'Y TO VERA Y'111E
<br /> ACCURACY OF T11E INFORMATION. 111F IA)CAL AGE'NC'Y IS RI3SPONSIBLI FOR TJIIi COMPLIA-TON Ol"111Ii
<br /> "I,OC;AL,ACyE,NCY USE ONLY"INI`ORMA711ON BOX AND FOR FORWARDING ON11 Lk)RM"A'ANI)AS,SO LV1'1;1)
<br /> FORM".B"(s)T,0 TLIE F011,0WING ADDRF-~&
<br /> SI'AII?OF CA1.111ORNIA
<br /> STNIT?WrVIER RIN' )URCII,S C OONIR2OL BOARD
<br /> C/o&W:Ia I?P.s.
<br /> DNI'A P ZOC II-S-SING C:T:>N'I"T',b
<br /> P.O.BOX 527
<br /> PARAMOUNT,CA 90723
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