BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

STATE OF CALIFORNIA � � •• `i STATE WATER RESOURCES CONTROL BOARD UNDERGROUN STORAGE TANK PERMIT APPLICATION • FORM B CO PLETE A SEPARATE FORM FOR EACH TANK SYSTEM. 7524-44 MARK ONLY ❑ 1 NEW PERMIT 3 RENEWAL PERMIT 5 INFO """"' U 7 PERMANENTLY CLOSED SITE I ONE RF7EM 2 INTERIM PERMIT 6 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.' 7524-44-SRU-1 B. MANUFACTURED BY: RHEEM C. DATE INSTALLED(MODAYA'EAR) I Q72 D. T'NK CAPACITY IN GALLONS: 8 , 000 II.TANK CONTENTS IFA-1 IS MARKED.COMPLETE REM C. A 'tJ 1MOTOR VEHICLE FUEL ❑ 4 OIL B. C. ❑ 1aUNLEADED 3 DIESEL ❑ 6 AVIATk3NGAS 86 ❑ 2 PETROLEUM ❑ 80 EMPTY � t PRODUCT GASAHOL� 1bUNLEADED Q 5 JET FUEL ❑ 2 WASTE ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN 2 LEADED ❑ I OTHER (DESCRIBE IN ITEM 0. BELOW) C. IF(At)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.0 III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,8,AND C.AND ALL THAT APPLIES IN BOX D AND A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 05 UNKNOWN SYSTEM 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK }� 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 6 STEEL CLAD Wl FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 6 100% METHANOL COMPATIBLE W/FRP (PrimaryTank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 96 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.I TENOR ❑ 5 GLASS LINING ❑ 6 UNLINED ER 95 UNKNOWN ❑ 90 OTHER LIN IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL 7 YES_ NO_ O.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION 1& 2 PRESSURE A U 3 GRAVITY A U 99 OTHER S. CONSTRUCTION A 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 96 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 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATNG A U 6 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR 2 UNE TIGHTNESS TESTING ❑ 3 M10T ING ❑99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING 4 AUTOMATIC TANK GAUGING❑ 5 GROUND WATER MONITORING 8 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE 95 UNKNOWN ❑ W OTHER VI.TANK CLOSURE INFORMATION I.ESTIMATED DATE LAST USED(MC/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERTMATERIAL? YES [:] NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT APPLICANT'S NAM / DATE PWL11E0 I46WHATU / ' 93 LOCAL AGENCY USk ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY x JURISDICTION 6 FACILITY A �-�--�T-A-NK�L-9-�� STATE I.D.#LJN of )o ® L_IIILllQ 1 PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE FORM 8 (7.91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN F1!10.