BILLING 1985-2006 - Laserfiche WebLink

Home Browse Search

r Official Registration Form 10, '0 California Water Resources Control Board Hazardous Substance Storage Statement t� _,4, Ail Who Must File: Each person sloring hazardous substances in any under- the tank. Wastes are Included. ground container must fife this term no later Than July 1. 1984 (After October Fee: For each tank registered a $10 l8e.MuELbs.. A&MM"t retail 1, 1984 and no later than January 1. 1985 for tanks used on lanmsl gasoline stations pay$5 per tank Definition of Underground Containers: The law applies to "concrete Penaltles:-Forfafture to file.the penalty is$500-$5.000 per day.li you falsify sumps, nonvautled burled tanks or other underground containers" (Water information, you can be fined up to $20,000 for each day the Information is Code section 131731 All contalnels. including earthen walled pits, ponds incorrect and has not been corrected lagoons and sumps. that are below the normal ground surface level must Confidentiality: If you have information protected by trade secret laws. register. A tank silting on the ground Is not included. Containers partially lease attach a list of the information on this form that is confidential and the beneath the surface are included l fined or unlined pits ponds and lagoons justification for confidentiality, including specific citations of relevant stalu- are covered it earth has been removed from file s1clage area to construct tory and ease law the facility. Normal grading is not considered construction below ground Multiple Containers: Fill I and II on one form and leave it blank on all the level. remaining forms. Attach all forms together securely. If you own more than Definition of Hazardous Substance: Any substance listed in Section 6382 50 tanks you can file information on computer tape. Cail 9161324-11262 for of the Labor Code or in Section 25316 0l the Health and Safety Code This inlovmation. includes: gasoline, diesel luei, all industrial solvents. pesticides, herbicides This is not a Permit Application. All Underground Tanks will be subject to and d of at a If the material must be carried by a mates red hauler. e to local regulation Some jurisdictions have alreadybegun programs. Check posed of at a hazardous waste 5lie,is explosive.generates pressure due to with your local count overnmenl for lurlher information p g heal or decomposition or would harm humans or wildlife you must register Y y g NOTE: ALL UNDERGROUND CONTAINERS MUST REGISTER EVEN IF STATE AND/OR LOCAL PERMITS ARE IN FARCE. I Ovener Name ICorporar+on.individual or Public Agency) Street Adpress r;dv Slate Z!P 7_�: II Facility racrlay Name Dealer/Foreman lsupervrsor Nearest cross Street Steel Address city County Zip Mailing Adaress Cay Slate Zip Phone wla,ea code Typo of Business ❑of Motor Vehicle Fuel Station ❑02 Other: -: NumtxH of Tanks at this Facrinv Rural Areas ?ownship iiange Section Only: III 24 Hour Emergency Contact Person Bays Name past name first)and Phone NiyhlS Name pest name first)and PhOne wl area coe COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER IV Description Container dumber(II there is no numow,ass,gn ones A. l Tank ❑o2 Sump ❑o3 Lagoon, Pit or Pond ❑04 Other B. Manufacturer (it appropriate): Year of Mfg.: — C. Year installed: k(,nknown D. Container Capacity:�_f� gallons ❑ Unknown F. Container Repairs: o1 None ❑u2 Unknown ❑o3 Yes Year: F. Is Container currently used? o, Yes ❑02 No If No, year of last use: ❑as Unknown G. Does the Container Store (Check One): ❑01 Waste 52 Product H. Does the Container Store Motor Vehicle Fuel or Waste Oil? ❑o1 Yes 2 No If Yes, Check appropriate box(es): ❑of Unleaded ❑o2 Regular ❑w Premium ❑04 Diesel ❑us Waste Oil r Ottler (Lisa) V Container Construction A. Thickness of Primary Containment: ❑ Gauge a Inches [P"c'mi ❑ Unknown t3. ❑of Vaulted (Located in an underground Vaulf.) o2 Non-vaulted Do-, Unknown C. ❑01 Double Walled BT-Sirigle Walled ❑03 Lined ❑04 Wrapped ❑o5 Unknown ❑o6 None D. Doi Carbon Steel ❑oz Stainless Steel ❑o3 Fiberglass ❑oa Polyvinyl Chloride ❑os Concrete ❑os Aluminum Steel Clad ❑as Bronze ❑o6 Composite El Non-metallic ❑ 1r Earthen Walls r C]12 Unknown ❑13 Other: E. ❑o1 Rubber Lined ❑02 Atkyd Lining ❑o3 Epoxy Lining ❑o4 Phenolic Lining ❑o5 Glass Lining ©06 Clay Lining o-, Unlined ❑ca Unknown ❑us Other. R Do; Polyethlene Wrap 0 rrr Vinyl pping ❑o3 Cathodic Protection 0 04 Unk n o5 None 0 oe Other: