Laserfiche WebLink
INSTRUCTIONS FOR COMPOVING FORM "B" <br /> GENERAL INSTRUCTIONS <br /> Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 <br /> of Chapter 67, Division 20, Health and Safe z,Code require tank owners to apply for an UST operating permit, <br /> 1. One FORM "B" shall be corrin" for each tank for all NEW PERMITS, PERMIT CHANCES, REMOV- <br /> ALS and/or any other TANK INFORMATION CHANGE. <br /> 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- <br /> GROUND TANK INSPECTOR. <br /> 3, Please type or print clearly all requested information. <br /> 4. Use a hard point writing instrument,you are making 3 copies. <br /> 5. Tank owners must 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 /> 6. Tank owners must submit documentation showing compliance with state financial responsibility require- <br /> ments to the local agency for petroleum USTs[2711 (a)(11) CCR]. <br /> TOP OF FORM: MARK ONLY ONE ITEM <br /> 1, Mark an (X) in the box next to the item that best describes the reason the form is being completed. <br /> 2. Indicate the DBA or Facility name where the tank is installed. <br /> I. TANK DESCRIPTION - COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY <br /> A. Indicate owners tank ID#- If there is a tank number that is used by the owner to identify the tank (ex. <br /> AB70789). <br /> B. Indicate the name of the company that manufactured the tank(ex. ACME TANK MFG), <br /> C. Indicate the year the tank was installed (ex. 1987), <br /> D. Indicate the tank capacity in gallons(ex 25,000 or 10,000 etc,), <br /> It. TANK CONTENTS <br /> A. 1. IF MOTOR VEHICLE FUEL, check box I 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 I is checked,in A), <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 A. <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 /> 1 If OTHER, print in the space provided. <br /> IV. 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 with 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 /> Vt. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1. ESTIMATED DATE LAST USED - MONTHIYEAR (January, 1988 or 01/88) <br /> 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). <br /> 3. 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 identification number is composed of the two digit county number, the three digit <br /> jurisdiction number,the six digit facility number and the-six digit tank number. The county and jurisdiction numbers are <br /> predetermined and can be obtained by calling the State Board(916)227-4303. The facility number must be the same as <br /> shown in form "A". The tank-number may be assigned by the local agency, however,this number must be numerical and <br /> cannot contain an alphabet. If the local agency prefers the State 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 ACCU- <br /> RACY OF THE INFORMATION, THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE <br /> "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND <br /> YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. <br />