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INSTRVCTIOiVS FOR COMPLETING FORM "B"
<br /> GENERAiI ;INSTRUCTIONS.:
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<br /> 1=- One FORK "B" she i Ir, t . ' eat:.h tank for all NEW`PERMITS,, PERMIT CHANGES. REMOVALS and/or any
<br /> othor TANK. INFORMATION C_mHANGE
<br /> Tr s`dorm 0oI be t or ui r t. ' ;:y r;then the PERMIT APPLICA147 or the LOCAL AGENCY UNDERGROUND TAMC
<br /> INSPECTOR. t
<br /> 3 Please, tyo:� er print. c It arly all requested information. `
<br /> 4 Use a hard-point-writing inscrament. you are making copies. - „-
<br /> TOP__OF 'FORM: 'MARK'"ONLY ONE ITEM" .,
<br /> 1 Mark an (X) ir) the. box next to the item.that best describes the reason the form is being completed.-
<br /> Indicate the:004!or Fac iity name where the tank i5 iristalted. `
<br /> 1 . TANK DESCRIPTION -•COMPLETE ALL ITEMS - IF UNKNOWN - SO SP f FY
<br /> A. irichcato c w ,r~ ta.:k 1D `Pf th; c (r, a ;:iris numbler drat is usedl:by the owner to ident i fy the tank
<br /> (ex A i( up: p
<br /> B 1nd(cat(:, the name of the company that man(.afacturgdJhe•tank,(ex. ACK TANK MFG).
<br /> C. Indicate the ye'arlhe tank was ,rst:al led (ex. 1"7')._-
<br /> rt (ex.
<br /> 1 niti ca+�e t,.he ank capar i , i r Ga 1 ons ns 25.DDD or 10.OOb
<br /> TANK CONTENTS #
<br /> A. 1, If MOTOR VLHICEE FLIFL, check box I and c!mplete items 8''8' C.;
<br /> 2. ,, A riot MC19R VLi1ICI.F 11.)F', • che(:i: the appropriate box in section A and complete items B & D.
<br /> fi Cherk the appropriat , box
<br /> -C Check the type o`, MP COR VEHICLE. F111.1- (if' box:'1 is checlto In A)~. ,
<br /> D Print the chemical name of the hazardoir,. the 'tank and the-C.A,.S,#. (Chemical
<br /> Abs tr]ICt. '5ervittl numt,(!r). i t bc.�x I 1 s No checked iti,.A..y.
<br /> III . TANK CONSTRUCTION - MARK ONE- ITEM ONLY. IN BOX .A. 8, C $ -D
<br /> 1 Check or•ly one item in TYPE_ ;7F �,Y T`M. TANK MATERIAL., J NTEPIOR1IkING and CORROSION PROTECTION.
<br /> 2 If O,HFR, print in the space pr vided.
<br /> IV. PIPING INFORMATION ,
<br /> f I. Circle Aif above . round circle U 1f under9 round, and circle both if :applicab le.
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<br /> I f� UNKNOWN c1 rcl e: or i f OTHER. pri nt in space.provjded
<br /> 3. Indicate the LEAK DETECTION system(s) used,to comply,,*th the :monitoripg requirement for the piping:
<br /> V. TANK LEAK DETECTION
<br /> 1 Indicate the LEAK DETECTIGN. system(s) used to comply,with,;hd-moniftiting requirements for the tank.
<br /> VI INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE }
<br /> 1. ESTIMAitlu QUANTITYofHAZA .DOUSISUBSTANCErmin ng �in988 rt4ie/tBank (in�Gall�on§T.'
<br /> USED 4
<br /> ,.. 2. E51 TMhiC.�.i (�i�r'SA ..��QI R (January, g -..
<br /> ?. WAS TANK .EILLEGrW;ITh INERT M IERJAL)_Cheek .'.Yes' or
<br /> APPLICANT MUST.SIGN AND DATE THE FORM AS INDICATED
<br /> INSTRUCTION FOR THE LOCAL AGENCIES
<br /> The-state underground sto`hage tank identification number is composed of the two digit county number, the three.
<br /> &g1t jurisdiction number;_ the six digit facility number and the svx;ai4jt -t,ik- number. •The county_. and. :
<br /> juri.sdictaon,numbsi"sre:predetermined and can be obtained by calling the State-Board%(916) .227-4303. The
<br /> facility-number must ,be":,t-he"same as shown in form "A".- The tank number.may be assigned_by the local -agency,
<br /> however-, this number must be numerical and cannot contain an alphabet. If the lacdl agency prefers the State .
<br /> Board -to,assign the tank number.-please leave it blank.
<br /> IT JS—THE•RESPONSIBILITY aOF THE 06AL AGEN6-THAT INSPECTS THE FACILITY T64ERIFY THE ACCURACY OF-THE
<br /> INFORMATION. THE LOCAL,AGENCY, IS RESPONSIBLE FOR THE .COMPLETION OF Tl-iE" "LOCAL AGENCY USE ONLY" INFORMATION BOX
<br /> AND FOR FORWARDING ONE FORM "A" AND ASSOCIATED FORM "B"(s) TO THE FOLLOWING ADDRESS.
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