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INSTRUCTIONS FOR COMPLETING FORM "B
<br /> GENERAL INSTRUCTIONS;
<br /> I One FORM "B" shall be completed for each rank for all NEW PERMITS, PERMIT CHANGES, REMOVALS and%or any
<br /> other TANK INFORMATION CHANGE.
<br /> 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK
<br /> INSPECTOR.
<br /> . ieasf type or print. clearly al ' requested information.
<br /> 4-. Use a hard point, writing instrument, you are making 3 copies,
<br /> TOP OF FORM; "MARK ONLY ONE ITEM"
<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 larility name where she: tank is installed.
<br /> I. TANK DESCRIPTION - COMPLETE ALL ITEMS a IF UNKNOWN - SO SPECIFY
<br /> A. ,ndirla",; r) rrs tank I.� # - If =fere is a tank number that is used by the owner to identify the tank
<br /> (ex, �).
<br /> F. i r,arrvE .f the comp r.r that r �riEaf cturad the tank (ex. A;,M` T,^NK M-G).
<br /> �s`�,'.rr, ii the Yea, the t.ar? r.
<br /> +. Was ", :atr]' �e�d ieX. 198!', •3 (f n
<br /> Lt. A. ., ;'� i,hn i^.'r'k capacity i t qa' �?�1 t, (ex. 5,'00 or 1fl,000 et,,)
<br /> II . TANK 1 CONTENTS p p
<br /> A. 1 IF MOTOR LE..I 7CLE�.. F�i��1, cheick box I and L.OMp P� it,'.'_,li�s B
<br /> 2. i f r )t. MUTT i.`E:(i C_E 1"i1E L, -h r k thf appr{; >ri at,� lox, e--!on :A and complete iters B & D.
<br /> B. Check the appropriate box.
<br /> C.
<br /> Check the (}E' of UIU<. vt:. `�` 1iJ:.... i I Do x ':.s {reCkE,i In Ai
<br /> G. Print the cif=r�ica' rtatie of the hazard=:;;: su) Fence stored in the tank and the t .`.>.#. (Chemical
<br /> Abstract Service number , r „o), i NOT chocked '€n A.
<br /> III. TANK CONSTRUCTION MARK ONE. ITEM ONLY IN BOX A, D, C & D
<br /> k :unl one iter
<br /> .n T`t'l �� &�: Fid F +, 1�blri ICF: t_IN Pdu ata i)?�C ICN E�OitC�::1i.
<br /> l( .:Nit ri spai.,, d.
<br /> IV. PIPING INFORMATION
<br /> I., Circe A 1f a L ov o ground circle U , undi,rground, and circle both if applicable.
<br /> 1, If l.INxPJJta!F< !pCr` 'f OTHER. print in space C;r,)J:ded
<br /> iCal;^ the LE.Ak EFTL(,T;` >yst'.."i{si 5el C0 cogii.}iy wilh t?1 f10r1'I''.yrjr}g requirement for the p' pin{i.
<br /> u.
<br /> V. TANK LEAK DETECTION
<br /> .. y .�e T?.'N s ..+. f e - .7 � s` . r" r;. .y Sr 'o-
<br /> `� tank.
<br /> 1 . s �fac�il_:. tt rE.,: [::FiE�,11 _ .,. ._, vc ;rr;1y ; th �.hr r)o is ^: i t, r` ,lr {,r )t.. .� tti�.
<br /> VI. INFORE ATpxIION ON TANK PERMANENTLY CLOSED IN PLACE
<br /> r Ole tan& or Gallons),
<br /> APPLICANT MUST" SIGN AND DATE THE FORM Ali w?,
<br /> INSTRUCTION FOR THE LOCAL AGENCIES
<br /> ,f, the two; djgit county number, the three
<br /> ��r=, jrber. The county an
<br /> rle
<br /> f ;: "ned b•y the local agency,
<br /> h=o wo`ver .lr` r r� d the l C<t. aoericy pref r"S to?C Mate
<br /> B arc i.,ci u _ .
<br /> TT Tri Tv
<br /> aw�� �r _OCAr W A ENCY USE ONLY" INFORMATION BOX
<br /> AND FOR FORWARDING ONE FORM "A' AND ASSOCIATED FORM 'B (s TO TIDE FOLd�t)WING ADDRESS.
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