BILLING 1985-1998 - Laserfiche WebLink

Home Browse Search

'�younc`�c STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD Q SIB UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, MARK ONLY ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED; I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.N S. MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR} D. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. C. FVIT 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. 1a REGULAR UNLEADED � 3 DIESEL L] 6 AVIATION GAS A Ib PREMIUM UNLEADED ❑ 4 GASAHOL 7 METHANOL ❑ 2 PETROLEUM ❑ 80 EMPTY 1 PRODUCT ❑ IC MIDGRADE UNLEADED ❑ 5 JET FUEL 8 M85 ❑ 3 CHEMICAL PRODUCT 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED Ej 99 OTHER(DESCRIBE IN ITEM 0.BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.q III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B,AND C,AND ALL THAT APPLIES IN BOX D AND E 1 DOUBLE WALL O 3 SINGLE WALL WITH EXTERIOR LINER a 5 INTERNAL BLADDER SYSTEM E 95 UNKNOWN A. TYPE OF SYSTEM � 2 SINGLE WALL ❑ 99 OTHER 4 SINGLE WALL IN A VAULT ❑ B. TANK D7 5 BARE STEEL F--] 2 STAINLESS STEEL ❑ 3 FIBERGLASS 4 STEEL CLAD Wl FIBERGLASS REINFORCED PLASTIC ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE WlFRP MATERIAL 5 CONCRETE 6 POLYVINYL CHLORIDE (Primary Tank) F-1 9 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER C.INTERIOR ❑ I RUBBER LINED 2 ALKYD LINING ❑ 3 EPDXY LINING 4 PHENOLIC LINING LINING OR 5 GLASS LINING ❑ 6 UNLINED ]�j 95 UNKNOWN 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO— D.EXTERIOR ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION 91 NONE 95 UNKNOWN ❑ 99 OTHER PROTECTION ❑ 5 CATHODIC PROTECTION ❑ SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) E.SPILL AND OVERFILL,81c. DROP TUBE YES NO STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO IV,PIPING INFORMATION CIRCLE A IF A80VE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH( A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 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 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLE WIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION U 95 UNKNOWN A U 99 OTHER 1 MECHANICAL UNE LEA(( 2 UNE TIG 3 CONTINUOUS INTERSTITIAL ❑A ELECTRONIC LINE ❑5 AUTOMATIC PUMP 99 OTHER t O D. LEAK DETECTION ❑ DETECTOR ❑ TESTING ❑ MOVORING LEAK DETEG70A SHUTDOWN V.TANK LEAK DETECTION FtqI VISUAL CHECK ❑ 2 RMANUAL ECONCILIATION MONITORING ❑ 3 MOO RING ❑ 4 AUTOMATGAUGING TANK ❑ 5 MONITORINGOUND WATER ❑ 6 TESTINGTANK 7 CONTINUOUS INTERSTITIAL ❑ 8 SIR ❑ 9 TAN1f GAUD MANUAL ❑10 MONTHLY TANK 95 UNKNOWN 99 OTHER MONITORING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST USED(M41DAYNR) 2.ESTIMATED QUANTITY OF 3,WAS TANK FILLED WITH YES ❑ NOX 1-2 _ _ 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 8 SIGNATURE) LOCAL AGENCY USE ONLY THE STATE , .NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.# m ` c, (>1 Ir {`' PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE I� m THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLIC N-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FOR"MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT pLWLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE WGROUND STORAGE TANK REGULATIONS FORM 8 (6.85)