BILLING 1999 - 2005 - Laserfiche WebLink

Home Browse Search

e ' STATE OF CALIFORNIA WATER RESOURCES CONTRY'L BOARD FORM 'B': UNz-RGROUND STORAGE TANK PRaaRAM 'o� TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING i ORMATION FOR EACH TANK. _ 1' MARK ONLY ❑ 1 NEW PERMIT 3 RENEWAL PERMIT CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED TANK ONE ITEM 2 INTERIM PERMIT ❑4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED FACILITY/SITE NAME WHERE TANK IS INSTALLED: '70 M FARM TANK-YES❑ NO G. I. TANK DESCRIPTION COMPLETE ALL ITEMS—IF UNKNOWN—SO SPECIFY '- OIL A. OWNERS TANK ID p B. MANUFACTURED BY: (( C. YEAR INSTALLED I G('o u D. TANK CAPACITY IN GALLONS: I 0 II. TANK CO TENTS IF(AT),IS MARKED,COMPLETE ITEM C.IF(A7),IS NOT MARKED,COMP E ITEM D. A. MOTOR VEHICLE FUEL ❑2 PETROLEUM B. C. NLEADED ❑ 2 LEADED ❑3 DIESEL ❑ 3 CHEMICAL PRODUCT ❑ 4 OIL PRODUCT ❑4 GASAHOL ❑ 5 JET FUEL ❑6 AVIATION GAS ❑ 5 HAZARDOUS ❑80 EMPTY ❑ 95 UNKNOWN ❑2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM D.BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED&C.AS.# h.Y C.A.S.# III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN SO1(A B,C,a D A TYPE OF ❑ 1 DOU WAUED ❑3 SNGLE WALLED WITH EXTERIOR UNER ❑ 95 UNKNOWN SYSTEM SINGLEWALBID ❑4 SECONDARYCONTAINMENT ❑99 OTHER STEEL/IflON ❑2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B.TANK ❑ 5 CONCRETE ❑6 POLYVINYLCHLORIDE ❑ 7 ALUMINUM ❑ 8100%METHANOL COMPATIBLE FRP MATERIAL ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑98 UNKNOWN Ej 99 OTHER G INTERIOR ❑ 'I RUUSS Ri-e""""UUNNEDD ❑2 ALKYD LINING ❑3 EPDXY LINING [:]4 PHENOLIC UNING LINING n- ""' �+ � El6 UNUNED ❑95 UNKNOWN ❑ IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? ❑YES ❑NO ❑99 OTHER D.CORROSION ❑ 1 POLYD"E'NMP TAA OR ASPHALT ❑3 VINYL WRAP 4 FIBEAGLPSSREINWRCEDPLASTIC PROTECTION ❑ 5 CATHODIC PPOTECTION ❑91 NONE ❑95 UNKNOWN ❑99 OTHER IV, PIPING INFORMATION CIRCIEA IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A SYSTEM TYPE A U 1 SUCTION A fj 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 91 NONE A<IUDMUNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CI—ADW/FRP A U 8 100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A(05 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 S 1 VISUAL CHECK /P/5 2 INVENTORY RECONCILIATION P 5 9 VAOOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS P S PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE I. ESTIMATED DATE LAST USED(MO/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH GALLONS SUBSTANCE REMAINING IN INERT MATERIAL? DYES [:] NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. APPUCANTS NAME(PRINTED 8 SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY* JURISDICTION# AGENCY# FACILITY ID# TANK 10#OD � = I � CURRENT LOCAL ADEN FACILITY 10♦ APPROVED BY NAME, PHONE#WITH AREA fODE T� -t2 .> 3 PERMIT NUMBER PERMIT APPROVAL DATE MI E%PIRA \,1j CHECK# PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT# BY: "- FORM B(6-29-88) THIS FORM MUST BE ACC OYP�h.rBY A FACILITY/SITE APPLICATION, FORM 'A',UNLESS�.,RRENT FORMA' HAS BEEN FILED DATA PROCESSING COPY ;�a4L�lu