BILLING_1997-2003 - Laserfiche WebLink

Home Browse Search

• • STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD irk, 4 UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT ❑ 3 RENEWAL PERMIT '._ 5.CHANGE OF INFORMATION E::] ] PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ d AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE e TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: A(zCO bac, D Iv I. TANK DESCRIPTION COMPLETE ALL REINS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.P 2 B. MANUFACTURED BY: X2�XL' S G DATE INSTALLED(MODAYNEAR) 3 I To'�) I D. TANK CAPACITY IN GALLONS: 2 U II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM O A M 1 MOTOR V09CLE FUEL ❑ d OIL B. C. to REG"UNLEADED 3 DIESEL ❑ 6 AVIATION GAS F72 PETROLEUM ❑ 80 EMPTY ErI PRODUCT /0 PREMIUM UNLEADED a GASAHMI� 7 METHANOL 1e MOGRADE UNLEADED 5 JETFUEL 7H 6 M65 ❑ 3 CHEIACALPRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE 2 LEADED 99 OTHER(DESCRIBENNEMD.BEDM 0. IF(A.I)IS NOT MARKED. INTER NAME OF SUBSTANCE STORED GAS.•: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A-B.AND C.AND ALLTHAT APPLIES IN BOX D AND E A. TYPE OF I DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR UNER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ d SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK ❑ I BARE STEEL ❑ 2 STAINlE55 STEEL �3 FIBERGLASS ❑ d STEEL CLAD W1 FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE 7 ALUMINUM E] B 100% METHANOL COMPATIBLE WIFRP ( rW-y T-k) ❑ 9 BRONZE ❑ 10 GALVAN= STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ d PHENOLIC LINING LINING OR ❑ 5 LASS LPiNG 6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER COATING IS LOVING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— G— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC CORROSION . PROTECTION ❑ 5 GT1001C PROlECRON ❑ 01 NONE ❑95 UNKNOWN ❑ 99 OTHER E SPILL AND OVERFILL,etc. SILL WNTNNMEM INSTALLED(YEAR) OVERHLL PREVENTION EQUIPMENT INSTALLED(YEAR) DROP TUBE YES_� NO_ STHIKERPIATE YES v NO_ DISPENSER CONTAINMENTM Y�y^ NO IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.BOTH IF APPUCABLE AL SYSTEM TYPE A U 1 SUCTION ki)2 PRESSURE A U 3 GRAVITY A U d FLEOBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL U 2 DOUBLE WALL A U 3 LVED TRENCH A U BS UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A CU FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W1 COATING A U B 100% METHANOL COMPATIBLE WFRP PROTECTION A U 9 GALVAM7F/D STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 Icawarx Ma IrAK ❑2 LNE TGKIIE4 ®3 canNlnlrs NrwsTmat a LLLCTRonc MF s AIfIOlM11C PUIP ❑ LelcsTOR TrsIN6 uorrtaasaG LTAK oErECIOP 9urooH+I 99 QiHER V.TANK LEAK DETECTION ❑ 1 VISUPL CHECK ❑ 2 MANUAL RECONCILIATIONINVENT ❑ 3 VADOZEMONITORING ❑ d GAUGINGC TANK ❑ 5 MONITORING GROUND WATER E] ANNUN-TANK 6 TESTING 7 MONITORIN G SG W� ❑ H SIR ❑ 9 T All AL ❑10 MONTHLY TANK TESTING ❑ 95 UNKNOWN ❑ 99 OTIiFA VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) I.ESTIMATED DATE LAST USED 0AOUAY/YR) 2-ESTIMATED W ANTTTY OF 3 WAS TANK FILLED WITH YES ❑ NO ❑ SUBSTANCE REMAINIG GALLONS INERT MATERIAL 7 THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNERS IPRM® 61GNATURID E DATE LOCAL AGENCY USE ONLY THE STATE LD.NUMB IS COMPOSED OF THE FOUR NUMBERS B OW J COUNTY♦ JURISDICTION M FACILITY Y TANK M STATE I.D.# m = I , C; ,V�4II PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE 444 THIS FORM MUST BE ACCOMPANIED BY A PERMIT AUINWAT10N-FORM A UNLESS A CURRENT FORM A HAS BEEN FILEjdhFW C MUST BE COMPLETED FOR INSTALLATIONS THIS FORM SHOULD BE ACCOMPANIED BY A PL FILE THIS FORM WITH THE LOCAL AGENCY UPLEPAE"WqWDERGROUND STORAGE TANK REGULATIONS FORM B