BILLING 1991 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B , o C�t1ia1.M.� COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ❑ 3 RENEWAL PERMIT ❑ 6 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE 1 NEW PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ B TANK REMOVED MARK ONLY O 2 INTERIM PERMIT ❑ 4 AMENDED PER ONE ITEM DBA OR FACILITY NAME WHERE TANK IS IN STALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS-- SPECIFY IF UNKNOWN B. MANUFACTURED BV: V. p. OWNER'S TANK I.D.% , K vO D. TANK CAPACITY IN GALLONS: C. DATE INSTALLED(MOIDAY(YEAR) v, ffll.TAN, KCj0NTENTS IFA-11S MARKED,COMPLETE ITEM C. toREGULAR 3 DIESEL ❑ 6 AVIATION GAS ❑ 4 OIL B. C. ❑ UNLEADED 4 GASAHOLVEHICLE FUEL lb PREMIUM ❑ 7 METHANOL Sa EMPTY ❑ 1 PRODUCT UNLEADED ❑ 5 JETFUELEUM ❑/ 3 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) drY�F 95UNKNOWN ❑ALPRODUCT C.A.S.. . )IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES 0.B.AND C,AND ALL THAT APPLIES IN BOX D 95 UNKNOWN ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER A. TYPE Of 99 OTHER SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTEDTANK) ❑ ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC 1 BARE STEEL B. TANK ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE 7,LUMINUM ❑ 8 100% METHANOL COMPATIBLE WIFRP MATERIAL ❑ 99 OTHER (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN 2 ALKYD LINING R'EPDXY LINING E] 4 PHENOLIC LINING E-1 1 RUBBER LINED ❑ 80 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 5 GLASS LINING ❑ 8 UNLINED LINING IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES_ NO_ NE WRAP D.CORROSION ❑ ❑ 3 COATING ❑ 3 IUNKNOWN ❑ 99 OTHER NYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC 1 POLYETHYLE PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 95 IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND,BOTH IRAF APPLICABLE A U 89 OTHER SUCTION A U 2 PRESSURE A U A. SYSTEM TYPE A"� A U 3 LINED TRENCH Ad� UNKNOWN A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL I A U 1 BARE STEEL A U 3 STAINLESS STEEL p U 3 POLYVINYL CHLORIDE(PVC)p U 4 FIBERGLASS PIPE C. MATERIAL AND 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLE WIFRP CORROSION A U UNKNOWN A U 99 OTHER SS TESTING PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION 7 INTERSTITIAL 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNE ❑ MgNRORING ❑ V.TANK LEAK DETECTION 1 VISUAL CHECK ❑ 3 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUNDWATER MONITORING [j ❑ 6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 3.WAS TANK FILLED WITH YES E] NO ❑ 2.ESTIMATED QUANTITY OF 1.ESTIMATED DATE LAST USED(MO/DAV/VR) SUBSTANCE REMAINING GALLONS INERT MATERIAL? KNOWLEDGE, IS TRUE AND CORRECT THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY DATE APPLICANT'S NAME (PRINTED b SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW TANK It COUNTY If JURISDICTION - STATE I.D.# PERMIT EXPIRATION DATE PERMIT NUMBER PERMIT APPROVED BY/DATE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORMA HAS BEEN FILED. FORM B (990) THIS FORM MUST BE Fo900340R/4 ^ • • I