BILLING 1986-2002 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNI WATER RESOURCES CONTRO,OARD FORM 'B': UNDEROUND STORAGE TANK PRO AM y TANK PERMIT APPLICATION INFORMATION ° TANK �GIbM0LkfI A 0PANATE FORM WITH THE FOLLOWING!pKORMATION FOR EACH TANK. MARK ONLY ❑ I NEW PERMIT F-13 RENEWAL PERMIT CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOS / ONE ITEM ❑2 INTERIM PERMIT F-14 AMENDED PERMIT ❑1 6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED r `] FACILITY/SITE NAME WHERE TANK IS INSTALLED; ZI S !� �Cli7 E /�-�� FARM TANK-YES❑t NO O I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-80 SPECIFY A. OWNERS TANK IDN B. MANUFACTURED BY: YV1 O 7/1'IV C.YEAR INSTA D G�� D. TANK CAPACITY IN GALLONS t 000 0 11. TANK RtiNTENTS IF(A•1),18 MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. 3 DIESEL A. 1 MOTOR VEHICLE FUEL F-12 PETROLEUM C. I UNLEADED ❑ 2 LEADED B. ❑ ❑ 3 CHEMICAL PRODUCT ❑ 4 OIL 1 PRODUCT ❑ 4 GASAHOL ❑5 JET FUEL ❑6 AVIATION GAS ❑5 HAZARDOUS ❑BO EMPTY ❑ 95 UNKNOWN ❑ 2 WASTE ❑7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.It: HAZARDOUS SUBSTANCE STORED&C.A.S.N 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D w A TYPE OF ❑ I DOUBLE WALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑2 SINGLE WALLED ❑ 4 SECONDARY CONTAINMENT ❑99 OTHER ❑ I STEEUIRON ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑4 STEEL CLADW/FIBERGLASS REINFORCED PLASTIC B.TANK �❑5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑7 ALUMINUM ❑ 8 100%METHANOL COMPATIBLE FRP MATERIAL ❑9 BRONZE ❑ 10 GALVANIZED STEEL ❑95 UNKNOWN ❑99 OTHER ❑ 1 RUSBERLINED ❑2 AUKYD LINING ❑ 3 EPDXYLINING ❑4 PHENOLIC LINING C. INTERIOR ❑5 GLASS LINING ❑6 UNLINED ❑95 UNKNOWN LINING ❑ IS LIMNG MATERIAL COMPATIBLE WITH IODI6 METHANOL? ❑YES ❑NO ❑99 OTHER 0.CORROSION ❑ I POLYETHLENE WRAP ❑2 TAR OR ASPHALT ❑ 3 VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 9/ NONE A U 95 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASSPIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P 8 1 VISUAL CHECK 11 8 2 INVENTORY RECONCILIATION 0 8 3 VADOSE WELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P 8 7 PRESSURE TESTING P 8 91 NONE P 8 95 UNKNOWN P 8 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1.ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3, WAS TANK FILLED WITH SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? ❑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 6 SIGNATURE) DATE I LOCAL AGENCY USE ONLY _. COUNTY N JURISDICTION k AGENCY M FACILITY ID R TANK ID N CURRENT LOCAL AGEfNNCY FACILITY)o N APPROVED BY NAME PHONE N WITH AREA CODE PERMIT NUMBER PERMIT APPROVALOATE PERMIT EXPIRATION DATE C _L CHECK F PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT A BY:tl-�1417 FORMB(6-29-88) THIS FORM MUST BE ACC;MPAN11reyAFACILRY/BRE APPLICATION, FORM 'A,UNLESS ACURRENT FORMA' HASBEENFILED DATA PROCESSING COPY