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1 UST-Tank Form Page 2 Instructions <br /> (Formerly SWRCB Permit Application Form B) <br /> Please number all pages of your submittal. <br /> 458. PIPING SYSTEM TYPE(UNDERGROUND)- For items 458 and 459, check the appropriate boxes to describe the type <br /> of product/waste piping installed in this tank system. Describe <br /> 459. PIPING SYSTEM TYPE(ABOVEGROUND)- underground and aboveground(if any) piping separately in the columns <br /> provided. <br /> 460. PIPING CONSTRUCTION (UNDERGROUND) - Check the appropriate box(es) to describe the type(s) of containment <br /> provided for the underground product/waste piping. <br /> 461. PIPING MANUFACTURER(UNDERGROUND)-Enter the name of the piping manufacturer. <br /> 462. PIPING CONSTRUCTION (ABOVEGROUND) - Check the appropriate box(es) to describe the type(s) of containment <br /> provided for any aboveground portions of the product/waste piping. <br /> 463. PIPING MANUFACTURER(ABOVEGROUND)-Enter the name of the piping manufacturer. <br /> 464. PIPING MATERIAL AND CORROSION PROTECTION (UNDERGROUND) - Check the appropriate boxes to describe the <br /> material(s)of construction of the primary (i.e. inner) underground product/waste piping and indicate whether any cathodic (i.e. <br /> corrosion)protection systems are installed. <br /> 465. PIPING MATERIAL AND CORROSION PROTECTION (ABOVEGROUND) - Check the appropriate boxes to describe the <br /> material(s)of construction of any primary(i.e. inner)aboveground product/waste piping and indicate whether any cathodic(i.e. <br /> corrosion)protection systems are installed. <br /> 466. PIPING LEAK DETECTION(UNDERGROUND)- For items 466 and 467, check the appropriate boxes to describe <br /> all leak detection method(s) used to comply with the monitoring <br /> 467. PIPING LEAK DETECTION(ABOVEGROUND)- requirements for regulated piping. <br /> 468. DATE DISPENSER CONTAINMENT INSTALLED-If the tank system is equipped with dispenser secondary containment(i.e. <br /> dispenser sumps or pans)equipment, enter the date that equipment was installed. If the tank system has a dispenser that is not <br /> secondarily contained,specify"None"in the space provided for the date. If the system does not include dispensers(e.g. standby <br /> generator tank system),enter"N/A." <br /> 469. DISPENSER CONTAINMENT TYPE - Check the appropriate box to describe how dispenser secondary containment is <br /> monitored for leaks. <br /> SIGNATURE OF OWNER/OPERATOR-The owner or an authorized agent of the owner shall sign in the space provided. This <br /> signature certifies that the signer believes that all information submitted is true,accurate,and complete. <br /> 470 DATE CERTIFIED-Enter the date the form was signed. <br /> 471. OWNER/OPERATOR NAME-Print or type the name of the person signing the form. <br /> 472. OWNER/OPERATOR TITLE-Enter the title of the person signing the form. <br /> 473. PERMIT NUMBER-This space is for agency use only. <br /> 474. PERMIT APPROVED BY-This space is for agency use only. <br /> 475. PERMIT EXPIRATION DATE-This space is for agency use only. <br /> UPCF hwfwm-b(1/99)-4/4 bttp://www.wiidoes.org Rev.02/16/00 <br />