Laserfiche WebLink
INS T R 3 T lONS FOR COMPLETING FORM «B" <br /> GENERAL INSTRUCTIONS <br /> Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25256.25237, and 25269 <br /> of Chapter 67,IDWIsion 20, Health and Safety Cady;require tank owners to apply for an UST operating permit. <br /> t. One FOR "B" shall be completed for,, adh tank for all NEW PERMITS, PERMIT CHANGES, REMOV- <br /> ALS and/or any other TAMC INFORIOATION CHANGE. <br /> 2, {leis fora should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER-_ <br /> ROUND TANK INSPECTOR, <br /> . Please type or print cl rly Gill requested information. <br /> 4. Use a hard point writing instrument,you are raking 3 copies. <br /> 5. Tank owners roust submit a plot plan to the local agency showing the location of the USTs with respect <br /> to buildings and-landmarks(2711 (a)(8)CCR]. <br /> Tank owners must submit documentation showing compliance with.state financial responsibility require- <br /> ments to the local agency for petroleum USTs[2711 (a)(91)CCR]. <br /> TOP OF FORM: MABK ONLY ONE ITE <br /> 1. Mark an(X)in the box next to the item that best describes the reason the form Is being completed. <br /> . Indicate the DBA or Facility name where the tank is installed. <br /> (. TANK DESCRIPTION - COMPLETE ALL ITEMS - IF U - 80 SPECIFY <br /> A. Indicate owners tank ID#-If there is a tank number that is used by the owner to identifytthe,,t ,(Ox.,,' <br /> A 70759). <br /> B. Indicate the Faroe of the company that manufactured the tank(ex.ACME TANK F <br /> C. Indicate the year the tank was Installed (ex. 1937). <br /> D. Indicate the tank capacity in gallons(ex.25,000 or 10,000 etc.). <br /> ll. 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 MOTOR VEHICLE FUEL(if box 1 is checked in ). <br /> D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical <br /> Abstract Service number), if box 1 is NOT checked in Aa <br /> Ill. TANK CONSTRUCTION - MARK ONE ITEM ONLY IN BOX A,..B, C & D <br /> 1... . . Check only one item in TYPE OF SYSTEM,TANK MATERIAL, INTERIOR LINING and CORROSION <br /> PROTECTION, <br /> 2. If OTHER,print in the space provided. <br /> IV. PIPING INFORMATION <br /> 1. Circle"A"if above ground circle"U'if undergrounds and circle both if applicable. <br /> 2. If UNKNOWN.N.circle;or if OTHER, print in space provided, <br /> 3, Indicate the LEAK DETECTION system(s)used to comply with the monitoring requirement for the piping. <br /> V. TANK LEAK DETECTION <br /> 1. Indicate the LEAK DETECTION sy tem(s)used to co iply with the monitoring requirements for the tank; <br /> Vl. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED-, ONTH RAR(January, 1988 or 01185) <br /> 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank(in Gallons), <br /> . WAS TANK FILLED WITH INERT MATERIAL? Check Yes"or"No". <br /> TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- <br /> CATED [see section 2711 (a)(13) CCR] <br /> INSTRUCTION FOR THE LOCAL AGENCIES <br /> The state underground storage tank identificati <br />