BILLING - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B 2 _ COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ❑ 7 PERMANENTLY CLOSED ON SITE MARK ONLY � NEW PERMIT 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ' ONE ITEM 2 INTERIM PERMIT FD AMENDED PERMIT E] 6 TEMPORARY TANK CLOSURE ❑ B TANK REMOVED I1 DBA OR FACILITY NAME WHERE TANK IS INSTALLED: /.700h e � (J I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN B. MANUFACTURED BY:UIESTt N /46 rlpe CO' A OWNER'S TANK I.D.M p p C. DATE INSTALLED(MOIDAY/VEAR) D / O/ O✓ D. TANK CAPACITY IN GALLONS: �QO II.TANK CONTENTS IF A-1 1S MARKED,COMPLETE ITEM C. DIESEL ❑ 6 AVIAT ON GA5 ® 1fl REGULAR UNLEADED ❑ 3 A ® 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C. ❑ 1b PREMIUM UNLEADED ❑ 4 GASAHOL ❑ 7 METHANOL ❑ 2 PETROLEUM ❑ So EMPTY 91 1 PRODUCT ❑ 10 MIDGPADE UNLEADED ❑ 5 JET FUEL ❑ B M85 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER(DESCRIBE IN ITEM D.BELOW) C.A.S.#: D. IF(A1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A S.AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN ED SINGLE WALL IN A VAULT El 99 OTHER SYSTEM 2 SINGLE WALL © 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ d STEEL CLAD W1 FIBERGLASS REINFORCED PLASTIC B. TANK s CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP MATERIAL ❑ (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL E] 95 UNKNOWN E:] 99 OTHER ® 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER LINING OR ❑ s GLASS LINING COATING IS UNING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ® 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION 91 NONE ❑95 UNKNOWN ❑ 99 OTHER PROTECTION ❑ s cATHoolc PROTEcnoN ❑ SPILL CONTAINMENTJNSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) E.SPILL AND OVERFILL,BTC. �— STRIKER PLATE YESNO_ DISPENSER CONTAINMENT YES_ NO DROP NBE YES NO__ IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U d FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGIE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U i BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CC CATHODIC PROTECTION 7 A UE 95/UNKNOWN A U 9910THERE7HANOL COMPATIBLE W/FRP PROTECTION AO 9 GALVANIZED STEEL A U 1 MEEHANILIL UNE UlX 2 UNE T.GIRNESS ❑3(XWnW0U5 WTERSTR4LL ❑I I—I ELEC niN UNE ❑5 AVfOAUTiL PUUP 99 OTHER D. LEAK DETECTION ❑ DETECTOR TESTING MOMTOPoNO LEAK DETECTOR L� V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK 2 MANUAL INVENTORY ❑ 3 MONITORING ❑ I GAUGINAUTOMATG MONITORING TANK ❑ 5 MONTORINGGROUND TER ❑B TESTING TANK RECONCILIATIONLY ❑ 7 CONMON TI INTERSTITIAL B SIR ❑ 9 TANKLY MANUAL ❑1D TES NG TANK ❑ 95 UNKNOWN 99 OTHER ORIN VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 2.ESTIMATED QUANTITY OF 3.WAS TANK FlLLED WITH YES ❑ NO 1.ESTIMAT AT LAST USED(MO/DAV/YR) SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDDDA EIS TRUE AND CORRECT TANK OWNER'S NAME n /�2 S 4e (PRINTED 6 SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW E� TANK# COUNTY# JURISDICTION FACILITY#Q 7L ( I� STATE I.D.# 0 PERMIT NUMBER PERMIT AP ROV BY/DAT PERMIT PIRATION DATE M ST BE D FOR THIS FORMMUST BE ACCOMPANIED BY A-9SHOULD BE ACCOMPANIED BY AIP OT PII fNLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTNGFORM A UNLESS A CURRENT FORM A HAS BEEN THEWGROUND STORAGETANKREGULATIIONSNS.THIS FOR FOR003I0-P7 FORM B (695)