BILLING 1985-1999 - Laserfiche WebLink

Home Browse Search

l STATE OF CALIFORNIA s STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B I COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT F7 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE .,.6 TANK REMOVED ' DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ! I -= 1 J dYLIJ t-v-/ I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.p B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAV/YEAR) tlM�d+�/ D. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. A. J 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C. ❑ to REGULAR UNLEADED ❑:3DESEL ❑ 6 AVIATION GAB 1 PRODUCT ❑ 1b PREMIUM UNLEADED ❑ SAHOL ❑ 7 METHANOL ❑ 2 PETROLEUM ❑ 80 EMPTY V� ❑ 1c MIDGRADE UNLEADED ❑ TFUEL ❑ B M85 3 CHEMICALPRODUCT 95 UNKNOWN ❑ 2 WASTE2 LEADED ❑ THER(DESCRIBE IN ITEM D.BELOW) D. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED A.S. III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B,AND C,AND ALL THAT APPLIES IN BOX 0 AND E ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN A. TYPE OF ❑ 99 OTHER SYSTEM IL�J� 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT 1 BARE STEEL E] 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL ❑ 5 CONCRETE � 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN 99 OTHER C.INTERIOR ❑ I RUBBER LINED 2 ALKYD LINING ❑ 3 EPDXY UNING ❑ 4 PHENOLIC UNING LINING OR ❑ 5 GLASS LINING 6 UNLINED ❑ 95 UNKNOWN E] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100°A METHANOL? YES_ NO!��\ D.EXTERIOR E] 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION ❑95 UNKNOWN 99 OTHER ❑ 5 CATHODIC PROTECTION 91 NONE PROTECTION OVERFILL PREVENTI4N�OUIPMENT INSTALLED(YEAR) E.SPILL AND OVERFILL.9SC. SPILL CONTAINMENT INSTALLED R) NO DISPENSER CONTAINMENT YES_ NO— IV. DROP TUBE YES_ NO STRIKER PLATE YES IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A i SUCTION A U 2 PRESSURE A U7GRAVIT�y77= PIPING A U 99 OTHERB. CONSTRUCTION A U 1SINGLE WALL A U 2 DOUBLE WALL A UHWN A U 99 OTHERC. MATERIAL AND A 1 BARE STEEL A U 2 STAINLESS STEEL A UHLOIBERGLASS PIPECORROSION A U 5 ALUMINUM A U 6 CONCRETE A UTIN00% METHANOL COMPATIBLE WIFRPPROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTIONNOOTHERD. LEAK DETECTION 1 MECHONICIL ONE LEU( 2 NNE RGMNESS 3 CONRNUDUS INTERSTmAL 4 ELECTRONIC UNE ❑5 AUTDNUIIDUMP g9 OTHER L CETECTOR TESTING MOMTCRMG LEAN CETECTOR SHUTDOWN V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑,.2 MANUAL LIATIONINVENT RY ❑ 3 MONOITORING ❑ 4 GAUG NGAUTOMATIC TANK [:35 MONITORING GROUND TER 6 TESTING ANNUAL 7 CONTINUOU INTERSTITIAL ❑ 8 SIR E] 9 WEEKLY MANUAL ❑10 MOTESTINGHLY TANK E:] 95 UNKNOWN 99 OTHER MITORIN VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST BED(MO/DAV R) 2.ESTIMATED OUANTITY OF 3.WAS TANK FILLED WITH YES ❑ NO I -w ' SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT DATE TANK OWNER'S NAME (PRINTED d SIGNATURE) t::n ttLOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW .3COUNTY# JURISDICTION# FACILITY# NK It STATE I.D.#PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EX THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A.UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THEfRGROUND STORAGE TANK REGULATIONS FORM 8 (6-95)