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INSU'RUC11ONS FOR COMPTHIING FORM 'B'
<br /> GENERAL 1,N9rRUC`110NS-
<br /> 1, One FCli1.:4 "13"shnH be con"Picted for cacti lan fesr >all NEW PERMT.VS,PERMUCIIANGUS, RE"MOVand/or an
<br /> .tier`I"ANK INIFf RMA 1"100 CIM.NGE
<br /> 2, This local should be cornpictod by either the PI,",I IT API"U' For the LOC AGE C„"Y UNI)EI3Ci3ISC3TTISD T°A K
<br /> INSPE,CUOR.
<br /> 3. Please ty'pc'or print cleady afl inf arm atiorr.
<br /> al. Use a h.anC 1 trot"a��€.a>" instnunnc,,5V, von arcmaking
<br /> TOP oil FORM: 'MARK K Cil L 10lgis 1`1111W
<br /> 1. Mark an (X) in the box next to the it€,nt that hest describes the reason the form is being completed.
<br /> 2. Indicate tfw D13A.or Fnilit,v na€nc where The tank is insta3led.
<br /> I. TANK DFSC I `TION-COMP I;E ALL UEMS- 'UNK CS -,S0 STECIFY
<br /> A. Indicate owners, tank ID #--If There is a tank number that is used by the,owner to identify the tank(ex. AI379789).
<br /> B, Indicate the nanre of the:company that manufactured the tank(ex.ACME TANK MFG.).
<br /> C. Indicate the year the tank was installed (ex. 1987).
<br /> 1), Indicate the tank capacity in gallons (ex,25,00ft or 10,C4(k')etc,).
<br /> 11, TANK CONIEN1.71%
<br /> A. 1 If MOaC3fi ATE"II€C1, FUl"'I.L,.,cheek boy I and complete items 13 & C
<br /> 1 If not ;lt)Oyt Vf',TI1C LE' I t LL, check the appropriate box in section A and complete items B& D
<br /> F3. Check the appropriate box"
<br /> C:. Check the type of MOTOR V EHICL I I UISI (if box I is checked In A).
<br /> L?. Print the cremical name ofthe ba ar ous seabstance stored in the tank and the C.A.S. . (Chemical Abstract'ser"ice
<br /> number),if"tsox 1 is ;SOT chic~ked in ,
<br /> IIT. TANK C Cbl I'RW ION-,MARK ONE HEM ONLY IN Il OX A,13,C
<br /> L Check only one item in'INT'l:tlla'SYSd13�I,"i"ASK hlt"T'EwI2Ir1I.,,rNuERIOR LINING and CORROSION L'ItC3TEC""1:10N,
<br /> 2. If CiTI]Fl , print in the space:pro-vridcd3
<br /> IV, PIPING INFO? A'I ON
<br /> 1, Circle A ii'above ground; circle IT if underground; area circle Troth if applicable:'
<br /> 2. if UNKt`Lt1WN,circle or if OzHEIZ print in space prx,ided.
<br /> 3. indicate the LEAK DITT.sC HON systcan(s)used to comply with the monitoring requirement for the pipin&
<br /> V. TANK LEAK DUI°E U170N
<br /> L Indicate the Ll-AK DFTI" CTt;.IN syste;n(s)used to comply with the monitoring requirements for the tank.
<br /> V1. INFORMN110N£7:°TANK I URMANisN11,Y CLOSED IN 1"IACF:?
<br /> 1. ESTIMA'ITE)C ATF I.A,TF USED-MO.N `IIJYI.v\R(January, 1988 or 01/88).
<br /> 2. I;,STIMA'II:I)QUANITFY of f 1AZARDOUS SUBSIA CK remaining in the tank(in Gallons),
<br /> 3, WASTANK FILLL?I) WI-111 1\I M' /VI`F1RJAL? Check'Yes'car' C3'.
<br /> A1' .ICA. I'MUST SKIN AND DNIE'111 FORM AS INDICAIT0.
<br /> INSFRUCITON FO 3 11i 1,£;a£.AL 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. 'Phe county and jurisdiction nutrtbem,are predetermined and
<br /> can be obtained by calling the State:Board (916)729-2421. The facility number must be the sarin 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 'ptafers the State Board to assign the tank number,please leave it blank.
<br /> 1"€ "ilii I2 SI£9 1SiI31I, ]:Y CC3 F° III31 7EAF..ACID C: '"IIA`.1"I fS IXTI '1111ri I?AC,II. I: `T f) I Idli Y 1111H
<br /> AC..URA(-f Cllr 11111 INIx) "T1ON. "37II13 LOCAL AGEN(W IS IZUSi'C3NSIIIIE I It THE CC MPI.£qIO OF°1ni
<br /> "WCAL e A(II N USE ONLY'INII)RMNIION PDX AND FOR M,WARDING ONE FORM W AND AW)C `i'E D
<br /> IF£) 213"{s)"I`£I'11TE IFOILO I £I AI3I91£E S.
<br /> 1WI"E"s LIEF CAI:IU IA
<br /> >,%',3 ,e esti
<br /> P.O.BOX S27 $
<br /> PA, .( O i ii`,8C F N 9723
<br />
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