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INSTRUCTIONS FOR COMPL.BTTNG FORM"B" <br /> GENERAL INSTRUCTIONS: <br /> 1. One FORI1"B"shall be completed for each tank for all NIT-W PERMTIS,PERME'T CEIANGE S, RFMOVAIS and/or any <br /> other TANK INFO )MON CHANGE. <br /> 2. "Phis form should be completed by either the PERMYr APPLIC'.ANF or the LOCAL AGENCY UNDERGROUND TANK <br /> INSPECTOR. <br /> 3. Please type or print clearly all requested information. <br /> 4. Use a hard point writing instrument,you are making 3 copies. <br /> TOP OF FORM:"MARK ONLY ONE IT1:14L" <br /> 1.. Mark an (X)in the box next to the item that best describes the reason the form is being completed. <br /> 2. Indicate the DBA or Facility name where the tank is installed. <br /> 1. TANK DESC'RIMON-C:OMPLUM ALI.MYTHS-IF UNKNOWN-SO SPECIFY <br /> A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank(ex.AB7078':, <br /> B. Indicate the name of the company that manufactured the tank(ex.ACME.TANK MFG.). <br /> C. Indicate the year the tank was installed (ex. 1987). <br /> D. Indicate the tank capacity in gallons(ex.25,000 or 10,000 etc.). <br /> U. 'TANK CONTENTS <br /> A. 1. If MOTOR VEHICLES FU1:1,check box.1 and complete items B R C. <br /> 2. If not MOTOR VEHICLE MEL,check the appropriate box in section A and complete items B& I). <br /> B. Check the appropriate box. <br /> C. Check the type of MOTOR VEHICLE FUEL,(if box I is checked in A). <br /> D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service <br /> number),if box 1 is NOT checked in A. <br /> III. TANK C.ON.S"TRUCTLON-MARK ONE YITiM ONLY IN BOX A,B,C dt D <br /> 1. Check only one item in TYPE OF SYSITM,TANK MA'ITRIAL, INTERIOR LINING and CORROSION PRO,rucrioN. <br /> 2. If O'TEIEIt,print in the space provided. <br /> IV. PIPING INFORMAITON <br /> 1, Circle A if above ground; circle U if underground; and circle both if applicable. <br /> 2. If UNKNOWN,circle; or if OTEEER,print in space provided. <br /> 3. Indicate the LEAK DEzl`EC FION system(s)used to comply with the monitoring requirement for the piping. <br /> V. TANK I.E?AK DPIECTION <br /> 1. Indicate the LEAK DEFECTION system(s) used to comply with the monitoring requirements for the tank. <br /> VI. INFORMAIION ON TANK PI RMANEMIM CLOSE)IN PLACE <br /> 1. FSMMA'IT'D DATE;I.AS`P USED-MoNmI/YE':"sAR (January, 1988 or 01/88). <br /> 2. MIMATED QUAN'T1TY of..ITA.ARDOUS SUB.S'I'ANCE remaining in the tank(in Gallons). <br /> 3. WAS TANK FILLED WPTII INERT MATERIAL,? Check 'Yes'or'NO'. <br /> APPLI(YWF MUST'SIGN AND DATE TME:FORM AS IINDICAMD. <br /> INSTRUCTION FORMF LOCAL AGENCIES <br /> The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction <br /> number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and <br /> can be obtained by calling the State Board (916)739-2421. The facility number must be the same as shown in form "A". The <br /> tank number may be assigned by the local agency; however, this number must be numerical and cannot contain an alphabet. If <br /> the local agency prefers the State Board to assign the tank number,please leave it blank. <br /> IT IS THE RESPONSTBRXIY OF MIE LOCAL.AGENCY TT1AT INSPI?CIS 11IF FACIIXlrY'PO VERIFY'ITIE <br /> ACCURACY OF 11IF INFORMA11ON. 11IE LCXAL ACYVNC Y 1S RESPONSIBLE FOR1711!COMPUMON OF T1IE <br /> *LOCAI.AGENCY Y USE ONLY"INFORMATION BOX AND FOR FORWARDING ONE FORM"A"AND ASSOCINnW <br /> FORM."13"(s)'1.0 ME:?FOLLOWING ADDRESS. <br /> STA II?OF CALIFORNIA <br /> STATE WRIER RESOURCES CONTROL BOARD <br /> C/O S.W.I?.E?P.S. <br /> DATA PROMSSING CTNTTR <br /> P.O.BOX 527 <br /> PARAMOUNI',CA 90723 <br />