BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

(bTA.TE OF CALIFORNIA ) WATER RESOURCES CONTRO' OARD FORM `B': UNDETMROUND STORAGE TANK PROMAM 02-- 'TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. C) ❑5 CHANGE OF INFORMATION ❑7 P RMANENTLY CLOSED TANK 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 8 TANK REMOVED /Q 9 MARK ONLY ❑ ❑q AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ONE ITEM ❑2 INTERIM PERMIT FARM TANK-YES❑ NO I N FACILITY/SITE NAME WHERE TANK IS INSTALLED: 1. co TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY B. MANUFACTURED BY: A. OWNERS TANK ID# D. TANK CAPACITY IN GALLONS: C.YEARINSTALLED I1.ZHAZARLDOUSSUSSTANCESE7;77w! ENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),ISNOT MC. 0 UNLEADEEDE ITEM Z LEADED ❑3 DIESEL B. VEHICLE FUEL ❑2 PETROLEUM ❑ I PRODUCT ❑4 GASAHOL ❑ 5 JET FUEL ❑6 AVIATION GAS AL PRODUCT �IL / 7METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) DOUS ❑ 80 EMPTY ❑95 UNKNOWN ❑.L•WASTE ❑ ❑R VEHICLE FUEL,ENTER NAME OF / , / 7'e �. r !,' CA.S.M 0SUBSTANCE STORED 8 C.A.S.# W CCC!!!"'(((///111 Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B.C,a D A TYPE OF ❑ I DOUBLE WALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN SYSTEM ❑2 SINGLE WALLED 4 SECONDARY CONTAINMENT ❑99 OTHER ❑ 1 STEELARON 2 STAINLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B.TANK ❑5 CONCRETE ❑ YVINYLCHLORIOE ❑ 7 ALUMINUM ❑8100%METHANOL COMPATIBLE FRP MATERIAL ❑9 BRONZE ❑'10 G VANIZ"STEEL ❑%UNKNOWN ❑99 OTHER ❑ 1 RUBBER UNED ❑2 ALKYD G ❑3 EPDXY LAMING ❑ 4 PHENOLICUNING C LINING INTERIOR ❑5 G7 LINING ❑6 UNUNED 1--��UNKNOWN ❑ ISUNINGMATERIALCOMPATIBLEWITH100%METHANO ❑YES ❑ NO I�aa OTHEP D. CORROSION ❑I POLYETHLENEWRAP ❑2 TARORASPHALT ❑3 VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑91 NONE 95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U I NDERGROUND,BOTH IF APPLICABLE A SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED AU 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESS STEEL A 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C.MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A USTEELCLADW/FRP A U 8100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 9 THER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECOND RY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P S I VISUAL CHECK P S 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P 8 91 NONE P 8 95 UNKNOWN P 8 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN OALLONB INERT MATERIAL? ❑YES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. APPLICANT'S NAME(PRINTED B SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# d l 0fOU 0007 CURRENT LQCAL AG�GY FAC`77 S APPROVED BY NAME � PHONE#WITH AREA CODE PERMIT NUMBER /}A PERMIT APPROVAL DATE 1 ERMIT EXPIRATION DATE CHECK M PERMIT AMOUNT SURCHARGE ANT. FEE CODE RECEIPT# BC FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIED o, A FACILITY/SITE APPLICATION, FORM 'A',UNLESS A CMMENT FORMA' HAS BEEN FILED I)-!> DATA PROCESSING COPY