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INKPRUC11ONS FSR C,'C.IiJ'IJT11 G IB a a B.
<br /> GEWERAL IM RIA €s 2 Sa
<br /> 1, One FORM"B" sh all be completed for each tank for all ? E i 4 I� `T' ANGE OVAI s and/or any
<br /> ooSha rTANK IIs ZOI C.dN C IANGF'
<br /> 2, This form should he `c m p, teal SI either the 1e•°1 ''APP1<f °or thel,C7CALA a U RG)R LINT)"I'
<br /> Il : "ECYO .
<br /> 3, please type or primclearly all noluested information.
<br /> 4, Use a hard plaint i xiting inatrwncnt,-you are making 3`copies,
<br /> 1, Mark �h (X) t box
<br /> reit name,b bent
<br /> that tank r de I
<br /> installed,es the reason the fonts is�being completed.
<br /> 2
<br /> I. TANK DIISC RIVI°ION (X)MI"f1:11?A,11,t l T' ,1,3,- 117 UNKNOWN-SO,
<br /> A, Inchcat€, owners I a i, "1FI# ..If there is a lank number that is used by the owner to ides-iif}the tank(ex.AB7I)789):
<br /> 31. Indica,1c ct., .lcri, of ih, ,.,orlipany that manufactured the,tank (ex.t1C ME?__'I'rk K MFG).
<br /> C, Indicate fine Vcar flw, tank-was ,ni i.lHed (ex. 19877)-
<br /> 1).
<br /> 98 -13. ..c>.c at,. 01c, ta,a ,alpaca i.. '<allons;cx.25,(tw or 1`J,000
<br /> It. TANK C O I`1r2S"I S
<br /> A, 1 1J gC; €1a1 I§1't(;Lt 1 t 1 1.,,check box 'g and complete tears R C;,
<br /> 1 <I.met M01`t`)=r. �l;ll1€.t F, check the appropriate box in acc4'cal A and complete items 11$ D.
<br /> R t xt r k the p pr a i st
<br /> C, Check eck Inc type of NRYFOR V1 111 C I FUEL (if box 1 is checked in A),
<br /> t). Print the circ .aiaal naire of the hazardous substance sPoand in the tank and the C",,S,#. (Chemical Abstract Seri-ice
<br /> 11,LP`;"bc ) if bo'c , is ()1 clickcd in A,
<br /> LII, TANK OON-'17t-UC1'IC l'°l--MARK ONE p1TM ONLY IN BOX A,13,C:&E3
<br /> L ('heck `r i",one itcm l F-I"' PF 01 I`t'S'U 41, .l`.ka:INK N1,Nl:"fsI'MAL, IICI'FRI(1EC LINING and CORROSION P12t)"IH I'ION.
<br /> . If 0TIf1FL print in the space provided,
<br /> IV. PTPI CT INFORNIXTION
<br /> 1. Circle A if above, gra un,, cc,cle, U.f undcr<,roand and€ircle both if applicable.
<br /> 2, If t'NL,.NCpWN s i, or iE x11111 t` print in space provided,
<br /> 1 h9dicale the 1,1., 1" DI:`a 3.R�?'1<3P s stern(s) used to comply with the monitoring requirement for she piping*
<br /> V. TANK LEAK TWITA-110IS
<br /> 1. Indicate the HH'AX DL T I;C TION systein(s) "ed it)comply with the monitorinIg reptsirenumts for the tank.
<br /> 1. 3� Ip1s�s I:L idrt t 1 I �f`1;53 1l a itlfd�l`I�fr i 1fZ(3anuars, 1�tls or 41J3fi).
<br /> 1 US]IMNI' ;) l,L=1. 1`I l Y of HAZA. DOL'S SUB1,""`ANC E r ntainistg in the t=real;(in Gallons).
<br /> 3. lk AS 1 ANK l a'I.1 1), H'II INTRT i<'t°I°ERTAL"?Check'Y s'qtr'NO'.
<br /> APPL'IC A I`MUSS'SIGN AxIf=I XI"11`3'IM DORSI AS INDIC NIE11.
<br /> IN1CFRUCXION F 1R'1`3111 1.,C)CL a C UINC'I3 S.
<br /> The state undegolund storage. tank identification number is composed ofthe two digit County number=the threedigit jurisdiction
<br /> number. the six digit,,a cibI ..a.€Ener and the six digit tank ilutntter. The county and jutisdiction numbers are predetermined and
<br /> can,he c'>1?t.asr ccs by calfin'r the ,tate Board (916)7311-3421. The i ac0iEy number must be the same as shout in fora"A". "Ihe
<br /> tank nurnbe a may he assigned lh the local agency- however, Phis number must be numerical and cannot contain an alphabet., I
<br /> the local agency prefer,tile Siate Board to a«ign the tank number,please learn it blank,
<br /> `IS TME PONS 311,U ' R'I'TE LOC C TtNC" `1 ' NS T. IS`ITS AC11 'I C F?I2II ILII?
<br /> C? .II C; OF'111F INFORMA110N, `I11E LOCAL AGITN( Y IS R0SPONSIBLE IX)R 1111;COMPI.XqION 0171111e
<br /> 'LOCAL A6F.N(-,Y USE CINL'"INI3ORMN O BO ,ISI) IAC R FORWARDING DING ONF3 FORM'A'AND ASSOCIX11:11)
<br /> Jk)RMEI(a)"IC 'I"IIIA ft(ILO ING ADDRESS.
<br /> 3' I ;Oil C"AT.IL'£ERNI
<br /> KPXO' +`d`7l SOURC C NI`F L BOARD
<br /> C#)Sm:FLE p.Sw
<br /> Fr O° BOX 527
<br /> F'IC1CAl4l1CF(INF,CA 90723
<br />
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