COMPLIANCE INFO_1986-1998 - Laserfiche WebLink

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4.9 w► ►w C UM=,Ul I WATER RESOURCES CONTRO ARD FORM `B': UND ROUND STORAGE TANK PRO AM TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EAC"TANK. C'+I,s OPM� MARK ONLY ❑I NEW PERMIT ❑3 RENEWAL PERMIT ®5 CHANGE OF INFORMATION ❑7 PERMANENTLY CLOSED TA K ONE ITEM ❑2 INTERIM PERMIT ❑4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED FACILITY/$ITE NAME WHERE TANK IS INSTALLED: Wrw S FARM TANK-YES❑ NO ❑ w 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY A. OWNERS TANK ID q B. MANUFACTURED BY: 00 C.YEAR INSTALLED D. TANK CAPACITY IN GALL S: II. TANK CONTENTS iF(A-1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A. ®1 MOTOR VEHICLE FUEL ❑2 ROLEUM B. C• ❑ 1 UNLEADED ❑2 LEADED ®3 DIESEL ®3 CHEMICAL PRODUCT: 4 OIL AM DUCT 4 GASAHOL 5 J U LJ ❑ ❑ EL ❑6 AVIATION GAS ❑5 HAZARDOUS ®80 EMPTY `❑95 UNKNOWN 2 WASTE ❑7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) 0. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED&C.A.S.q C.A.S.q: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN Box A.B,C,&D A.TYPE OF ®I DOUBLE WALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER . ❑95 UNKNOWN SYSTEM ❑2 SINGLE WALLED ®4 SECONDARY CONTAINMENT ®99 OTHER B.TANK ❑1 STEEWUIRO! ❑2 STAINLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑7 ALUMINUM ❑8 100%METHANOL COMPATIBLE FRP ❑9 BRONZE ❑10 GALVANIZED STEEL ❑95 UNKNOWN ®99 OTHER C.INTERIOR ®i RUBBER UNED ❑2 ALKYD UNINO ❑3 EPDXY LINING ®4 PHENOLIC LINING LINING ❑5 GLASS LINING ❑6 UNLINED ❑95 UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 10Q%METHANOL? ❑YES [:1 NO ❑99 OTHER D-CORROSION ❑I POLYMLENE WRAP ❑2 TAR OR ASPHALT ®3 VINYL WRAP ®4 FIBERGLASS REINFORCED PLASTIC PROTECTION ®5 CATHODK PROTECTION E]91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A.SYSTEM TYPE A U i SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B.CONTRUCTIO,N A U i SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER A U 1 STEELARON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE Q MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP A U 9GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER V. PEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P 8 1 VISUAL CHECK P 8 2 INVENTORY RECONCIUATION P 8 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P 8 7 PRESSURE TESTING P 8 91 NONE P 8 95 UNKNOWN P 8 99 OTHER VI. INFORMATpN ON TANK PERMANENTLY CLOSED IN PLACE 1.ESTIMATED DA I LAST USED(mo YR) 2.ESTIMATED QUANTITY Of SUBSTANCE REMAINING IN 3•WAS TANK FILLED WITH GALLONS INERT MATERIAL? =YES [M:] THIS FORMtiAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. AE0L6NT'S NAME(PRINTED&SIGNATURE) DATE LOCAL AG Y USE ONLY COUNTY q JURISDICTION M AGENCY q FACILITY ID M TANK ID q d CURRENT LOCAL AGENCY FACILITY ID q + APPROVED BY NAME PHONE N WITH AREA CODE PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE J CHECK q PERMIT AMOUNT SURCHARGE AMT. `/s FEE CODE RECEIPT q BY: FORM B(6-29-as) THIS FORM MUST BE ACCOMPANIED ACIUi Y/SITE APPLICATION, FORM'A',UNLESS A C ._.,.ICT FORM W HAS BEEN FILED i DATA PROCESSING COPY