COMPLIANCE INFO_1984-1998 - Laserfiche WebLink

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INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS: 1, One FORM "n'° .shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES, REMOVALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR, 3. Please typ=e or print clearly all requested information -4.' Use a hard point writing instrument, you are making) 3 copies. TOP OF FORM. 'MARK ONLY ONE ITEM" 1. Mark an. (.X) in the box.next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or � c,ility name where the tank is installed. , I. TANK DESCRIPTION - COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG), C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25.000 or 10,000 etc.) II. TANK CONTENTS A. I. IF MOTOR VEHIC..E FUEL, check box 1 and compiet.e items B & C. 2. If not MOTOR VEH.C..E FUEL, check the appropriate box in section A and complete items B & L. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE EUEi_. (if box 1 is checked in A). D. Print the chenica' name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number; : if box 1 is NOT checked in A. III, TANK CONSTRUCTION - MARK ONE ITEM ONLY IN BOX A, B> C & D 1. Check only one item in TYPE OE SYSFEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTECTION. 2, If OTHER. , int iri f he spac::e prow ided. IV. PIPING INFORMATION C t;c l e A i f abo•��e ground circle U i undert:1round, and circle both if applicable. �. I . .NrN �-.d c:; 1 . or. if .T;.ER.. i:�t r, space provided Indicate the LEAK DEIECTI t system(s)t;rm(s) u ed to com ly with the monitoring requirement for the piping. V. TANK. LEAK. DETECTION 1. indicate, the. LEAK DETE,:TIO" sv; esi used 3r)ly with the mariitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED - MONTH/YEAR (January. 1988 or 0.1/88) 2. ESTIMATED QUANTITY of H,;`;