BILLING_1997-2003 - Laserfiche WebLink

Home Browse Search

• • aao STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B << , 1 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE ONE REM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ B TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.# (,j—!�s — Z_ I B. MANUFACTURED BY: C. DATE INSTALLED(MOIDAY/YEAR D. TANK CAPACITY IN GALLONS: ©Q,p II.TANK CONTENTS IFA-11S MARKED,COMPLETE ITEM C. MOTOR VEHICLE FUEL ❑ 4 OIL B. C. ❑ 1a REGULAR UNLEADED ❑ 3 DIESEL ❑ 6 AVIATION GAS 2 PETROLEUM 80 EMPTY PflODUCT 1b PREMIUM UNLEADED ❑ 4 GASAHOL ❑ 7 METHANOL ❑ ❑ ❑ 1t MIDGRADE UNLEADED ❑ 5 JETFUEL ❑ 8 M85 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTTER(DESCRIBE IN REM D.BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A S.#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.S.AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF 0 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL �3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE WIFRP (Primary Tank) ❑ 9 BRONZE ❑ /0 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING LINING OR ❑ 5 GLASS LINING 'Nit 6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YESlk NO— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC CORROSION 91 NONE 95 UNKNOWN 99 OTHER PROTECTION ❑ 5 CATHODIC PROTECTION ❑ ❑ ❑ SPILLCONTAINME T STALLED(YEAR) OVERF REV EN I ION EQUIPMENT INSTALLED(YEAR) E.SPILL AND OVERFILL,ete. DROP TUBE YES NO_ S^RIKER PLATEYES NO_ DISPENSER CONTAINMENT YES NO IV.PIPING INFORMATION CIRCLE AIFABOVE GROUND ORULIFUNDERGROUND,BOTH IFAPPLICABLE A. SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U / BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PA 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER MECHANICAL ONE LFAX 2 UNE 1p$S 3 CC NS INIEPSTRIAL ❑d BETIC LINE E]5 AIRCAUTIC P9A'P ❑ 99 OTHER D. LEAK DETECTION ❑1 9 =R ❑ =110 9m4MRINo IFAETECTaI sxumov#I V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 MANUALILIATONORY ❑ 3 MONOITORING 4 GAUL NGIC TANK ❑ 5 MONITORINGROUND G TES❑ 6 TTEESRECONCTINGTANK ❑ 7 MONITORU INTERSTITAL E::] 8 SIR ❑ 9 7p GAUGINGAL ❑10 MESTNGY TANK ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES ❑ NO❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO T EST OF MY KNOWLEDGE,IS TRUE AND CORRECT i TANK OWNER'S NAME DATF e S(PRINTE0451GNANREI &2_ LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FO R NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.Dl m 0 PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE -11 MUST BE D FOR THIS FORM MUSTSHOULD BEA ACCOMPANIED BY AI PLOT PIOILE THIS ORMLWTH THE LOCAL AGENCY IMPLEMENTING THEUNESS A CURRENT FORM A HAS BEEN FILED. JWGROUND STORAGEE TANK RINS.THIS FORM REGULATIONS FORM B (6.95)