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INSTRUCTIONS FOR COMPLETING FORM ''B''
<br /> GENERAL INSTRUCTIONS:
<br /> 1 One FNM Bski! be c-,raiplet:ed for each tank for all NEW PERMITS, PERMIT GLANCES, REMOVALS and/or any
<br /> other TANK INFORMATION CHANGE,
<br /> 2 This form .hojlo be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANS
<br /> INSPECTOR.
<br /> 3. Please ty e or print., c€early all
<br /> requested information,
<br /> z Use a hard point writing in instrument. you are making 3 co !f s.
<br /> TOP OF FORM. 11ARK i1NI-Y ON.A ITEM"
<br /> l.. ,`''tark .an X) 'Y:,.,the box next to the item that best describes te reason the form �5 being completed.
<br /> 2. indicate the )(1A orFacility name where the tank is installed,
<br /> In TANK DESCRIPTION m COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY
<br /> A. indicate owners trek 1D I -- If there is a tank rl'jmber that is used by the owner to identify the tank
<br /> (ex. /A1310+89) .
<br /> B. indicate the name of the company that manufactured the tank (ex. AME. TANK MFG).
<br /> C. Indicate the year the tank was installed (ex. 1987),
<br /> 0. Indicate the hank capacity in gallons (ex. 25,000 or 10,000 etc. }
<br /> H. TANK CONTENTS
<br /> A 1 IF fit.}IOR vi.HICL FUEL, check box 1. and complete items B C,
<br /> not �&I OVEHICLE FUEL, heck the appropriate boA ir se'. ;on.A and complete items B & Li.
<br /> B, CheCKtheappropriate box, 7 &&,,
<br /> C Check the type of MOTOR VEHICLE FUEL z box is checked .
<br /> D. Pr'lnt, the em7ca1 name of the hazardous subsiance stored n the tank and theC.A. ?..#. (ChemicalPkb
<br /> Abstract Service number). if box 1. is NOT checked in A,
<br /> III. TANK CONSTRUCTION - MARK ONE ITEM ONLY IN BOX A, C, C & D
<br /> 1Check only one item in TYPE OF' SSE €, TANK MATERIAL, INTERIOR
<br /> I rR1 ,l iIt ;PG and CORROSION
<br /> CRrCSION P Rrr i ,'I
<br /> O
<br /> N,
<br /> 1 if r HER print in the space provide.
<br /> IVa PIPING INFORMATION
<br /> 1. Circle A if above ground circle U if underground, and circle both if applicable.
<br /> 2, If UNKNOWN circle; or if OTHER, print in space provided
<br /> 3. Indicate the LEAK DETECTION system(s) used to comply pith the monitoring requirement for the piping.
<br /> V. TANK LEAK DETECTION
<br /> 1.. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank,
<br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE
<br /> 1. ESTIMATED DATE: L.AS1T USED - MONIH/YEAR (January, 1988 or 01//38)
<br /> 2, ESTIMATED QUAN 1 Y of HAZARDOUS SUBSTANCE: remaining in the tank tin Gallons),
<br /> 3. WAS TANK FILLED WITH INERT MATERIAL? Check `Yes` or `NO' ,
<br /> APPLICANT MUST SIGN AND DATE THE FORM AS INDICATED.
<br /> INSTRUCTION FOR THE LOCAL AGENCIES
<br /> The state underground storage tank identification number is composed of the two digit county number, the three
<br /> digit jurisd'iction number, the six digit, facility number and the six digit tank number. The county and
<br /> jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The
<br /> facility number must; be the same as shown in form "A". The tank number may be assigned by the local agency,
<br /> however, this number must be numerical and cannot contain an alphabet, if tha local agyncy. prefers the State
<br /> Board to assign the tank number, please leave it blank.
<br /> IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCURACY OF THE
<br /> INFORMATION, THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE 'LOCAL AGENCY USE ONLY' INFORMATION BOX
<br /> AND FOR,FOR ARDING LONE" FORM °'A" AND ASSOCIATED FORM `'B"(s) TO THE FOLLOWING ADDRESS,
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