COMPLIANCE INFO_1995-1999 - Laserfiche WebLink

Home Browse Search

INSTRUCTIONS FOR COMPLETING FORM "B GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25280 of Chapter 6.7, Division 20, Health and Safety Godo require tank owners to apply for an UST"operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES, REMOV- ALS and/or any other TANK INFORMATION GRANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL.AGENCY UNDER- GROUND TANK INSPECTOR. 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument,you are making 3 copies. a Tank,Qwn ro must submit a plot plan to the local agency showing the location of the USTs with respect tc bi ildihja and landmarks(2711 (a)(8)CCR]. 6. Tan 'bwners must submit documentation showing compliance w(th stet financial responsibility require- ments to the local agency for petroleum USTs [2711 (a)(11) CCR), `OP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to the item that best de cribes the reason the form is being completed. 2. Indicate the DBA or Facility nam where the tank is installed. I. TANK DESCRIPTION m COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID#m If there is a tank number that is used by the owner to identify the tank(ex. AB701783). B. Indicate the name of the company that manufactures the tank(ex. ACME TANK MFG), C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex.25,6601 or 101>000 etc.). It. TANK CONTENTS A. 1, IF MOTOR VEHICLE FUEL., check box 1 and complete items B&C. 2. If not MOTOR VEHICLE FUEL,check the appropriate box in section A and complete items B&D. B. Check the appropriate box. G. Check the type of MOTOR VEHICLE FUEL.(if box 1 is checked in A). D. Print the chemical name of the hazardous substance stored in thertaAk and the C.A.S.#. (Chemical Abstract Service number), if box 1 is NOT checked in A. III. TANK CONSTRUCTION - MARK ONE ITEM ONLY IN BOX A, B, C & D 1. �Cbeck only one item in TYPE OF SYSTEM,TALK Y =TERIAL., INTERIOR LINING and CORROSION N PROTECTION. 2. If OTHER, print in the space provided.. IV. PIPING INFORMATION 1. Circle"A" if above ground circle "U" if underground, and circle goth if applicable. 2. If UNKNOWN circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s)used to come ['with the monitoring requirements for the tank. V . INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1, ESTIMATED CRATE LAST"USED-"S NTH/YEAR (January, 1088 or 031/88) 2. ESTIMATED QUANTITY of HAZARDOUS ARDOU SUBSTANCE remaining in the tank (in Gallons), . WAS TANK FILLED WITH INERT MATERIA? Check"Yes"or"No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND GATE THE FORM AS INDI- CATED [see.section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The stat!undergfo and storage tank identification number is composed,of the two digit county number,the,three digit jurisdiction number,the six digit facility number and the six digit tank number. The county and)uiisdictioln'r umbers°are predetermined and can be obtained by calling the Stag Board (916)227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency,however;this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL. AGENCY 1S RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INF DATION BOX. THE LOCAL AGENCY SH r3 RETAIN THE ORIGINAL AND YELLOW COPIES. THE Pit G SHOULD BE RETAINED BY THE TANK ER.