BILLING 1986-1994 - Laserfiche WebLink

Home Browse Search

• STATE OF CALIFORNIA • •cspOR, co STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE ASEPARATE FORM FOR EAC9 TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED /S DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 2'31— r S,Cd ff S S, fT/7+ I. TANK DESCRIPTION CO EA ITE - SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# O S/ B. MANUFACTURED BY: u�L_ C. DATE INSTALLED(MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: ILTANKCONTENTS IFA-11SMARKED,COMPLETE ITEM C. A. ❑ 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. 7PRDUCT C is REGULAR o 3 DIESEL ❑ 2 PETROLEUM SO PT. ❑ UNLEADED PREMIUM ❑ 4 GASAHOL ❑ 6 AVIATION GAS ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ ❑ 16UNLEADED ❑ 5 JET FUEL ❑ 7 METHANOL ❑ ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OFSUBSTANCE STORED C.A.S.# III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXESA,B,AND C.AND ALL THAT APPLIES IN BOX A. TYPE OF ❑ 1/ UBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER L1��,/ ❑ 95 UNKNOWN SYSTEM 2 SING WALL ❑ 4 SECONDARY CONTAINMENT (VAULTEDTANK) ❑ 99 OTHER S. TANK 1 R ST ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCEDPLASTIC MATERI 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP (PrlmaryTan ❑ 9 BRON ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER 1 RUBBER LINED 2 ALKYD LINING C.INTERIOR ❑ 3 EPDXY LINING p 4 PHENOLIC LINING LINING ❑ 5 GLASS LINING ❑ 6 UNLINED ❑ 95 UNKNOWN 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 10D% METHANOL? YES_ NO D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IFASOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U i SUCTION A U 2 PRESSURE A U 3 GRAVITY ACU 99 OTHER B. CONSTRUCTION A 1 SINGLE W L A U 2 DOUBLE WALL p U 3 LINED TRENCH q U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 7 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM 6 CONCRETE A U 7 STEELW/COATING A U B 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION p U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 31NTERST KL MONITORING ❑98 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 POR MONITORING❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING ❑ e TANK TESTING ❑ 7 INTERSTITIALMONITORING B7 NONE ❑ 96 UNKNOWN ED99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH L p AC-1,f17 / / SUBSTANCE REMAINING GALLONS I INERTMATERIAL7 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 8 SIGNATURE) QATE LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW STATE I.D.# COUNTY# JURISDICTION# FACILITY# TANK �R `/ .ySO -3 PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPI TI 14 DATE i4y/Y3 FORM B(9.90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FOR00108414