BILLING - Laserfiche WebLink

Home Browse Search

• a ee STATE OF CAUFORMA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION• FORM B /� G COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM N A �5 CHANGE OF INFORMATION O 7 PERMANENTLY CLOSED ON SITE 1 NEW PERMIT ❑ 3 RENEWAL PERMIT (� MARK ONLY ❑ ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ B TANK REMOVED ONE ITEM L1 2 INTERIM PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALLITEMS- SPECIFY IF UNKNOWN S. MANUFACTURED BY: v, �. A. OWNER'S TANK I.D.# Y , /� v• /i C. DATE INSTALLED(MO/DAYrYEAR) v D. TANK CAPACITY IN GALLONS: l'^ ILTANKCONTENTS IFA-11S MARKED,COMPLETE ITEM C. 1a REGULAR ❑ 3 DIESEL ❑ 6 AVIATIONGAS ❑ 4 OIL S. C' ❑ UNLEADED 4 GASAHOL A ❑ t MOTOR VEHICLE FUEL 1 PRODUCT ib PREMIUM ❑ ❑ 7 METHANOL ❑ 2 PETROLEUM ❑ BO EMPTY ❑ ❑ UNLEADED ❑ 5 JET FUEL 5 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESC El 3 CHEMICALPRODUCT �9RISE IN ITEM D. BEL C.A.S.N: D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED ��'l�A�_r5 H V•K. Z3�S-ID III. TANK CONSTRUCTION MARK ONE ITEM ONLY❑ IN BOXES 3 SNGLEAWALL WITH EXTERORTLINER ES IN BOXD 95 FUUNKNOWN 'V G ❑ 1 DOUBLE WALL 99 OTHER A, TYPE OF E] 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ SYSTEM ❑ 2 SINGLE WALL ❑ 1 BARE STEEL 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W1 FIBERGLASS REINFORCED PLASTIC B TANK6 POLYVINYL CHLORIDE 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP 5 CONCRETE ❑ MATERIAL ❑ ❑ (Primary Tank) ❑ 9 BRONZE 1O GALVANIZED STEEL 95 UNKNOWN es OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING 3 EPDXY LINING ❑ d PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING ❑ 6 UNLINED 95 UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? VES_ NO_ ❑ 2 COATING 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC D.CORROSION ❑ 1 POLYETHYLENE WRAP FVr95 UNKNOWN ❑ 99 OTHER PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE IV.PIPING INFORMATION CIRC, A IF ABOVE GROUND OR U IF UNDERGROUND,B3 H IF GRAVITVOABLE A U 99 OTHER A U 1 SUCTION A U 2 PRESSURE A U A. SYSTEMTYPE A ^ 5 UNKNOWN A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 1 BARE STEEL A U A 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE C. MATERIAL AND U 5 ALUMINUM A U B CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WIFRP CORROSION 10 CATHODIC PROTECTION A�5 UNKNOWN A U 99 OTHER PROTECTION A U 9 GALVANIZED STEEL A U 3 IMERS ITIAL 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ MONrtORING ❑ V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING 4 AUTOMATIC TANK GAUGING [:] 5 GROUNDWATER MONITORING ❑ 6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 3.WAS TANK FILLED WITH YES ❑ NO❑ 2.ESTIMATED QUANTITY OF GALLONS INERTMATERIAL7 1.ESTIMATED DATE LAST USED(MO/DAVIYR) SUBSTANCE REMAINING ERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF P APPLICANTS NAME (PRINTED a SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW TANK# COUNTY# JUrRI�SDICTION# FACILITY TE I.D.# L� yONDATE UJ [PER:MITNU:MBER PERMIT APPROVED BV/DATE PERMIT EXPIRATION DATE �.T• FORM 8 (990) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORMA HAS BEEN FILED. 1 FOR00948