San Joaquin Valley Air Pollution Control District
Supplemental Application Form
Permit Application for Existing Gasoline Tanks
TANK(S) DESCRIPTION
(a)Tank Size (Gallons) / (b)
Liquid Stored / (c)
Aboveground or Underground / (d) Throughput / (e)
Is the tank used primarily for refueling implements of husbandry?
(Yes/No) / (f)
Is the tank equipped with a permanent submerged fill pipe?
(Yes/No) / (g)
Is the tank equipped with an offset permanent submerged fill pipe?
(Yes/No) / (h)
Date of Installation of tank
Monthly
(gallon/month) / Annual
(gallon/year)
550 gallons* /
Gasoline*
/ Aboveground* / 1,000 gallons* / 12,000 gallons* / Yes* / Yes* / No* / 1/1/76**Note: This first row is presented as an example. See instructions for further information. Attach additional sheets if needed.
APPLICATION FOR
PERMIT FOR EXISTING GASOLINE TANKS
-INSTRUCTIONS-
Note: Do not include gasoline storage tanks that have a capacity of less than 250 gal and tanks that store diesel or LPG/propane in completing this application form.
The following data and specifications must be provided for each tank that is required to be permitted:
a) Tank Size – The size of the gasoline storage tank or gasoline compartment of a multiple compartment tank.
b) Liquid Stored – State the type of liquid stored in the tank.
c) Aboveground/Underground – Please state whether the tank is buried underground or mounted aboveground.
d) Monthly and Annual Throughput – How much gasoline is dispensed from the storage tank in an average month and in a calendar year.
e) Tank(s) primarily used to refuel implements of husbandry – A gasoline storage tank with a capacity of 550 gallons or less used primarily for the refueling of implements of husbandry, and equipped with a permanently submerged fill pipe, is exempt from Phase I vapor recovery system requirement.
Implement of Husbandry is a vehicle that is used primarily in the conduct of agricultural operations.
f) Permanent Submerged Fill Pipe – A permanent submerged fill pipe is defined as any fill pipe, the discharge opening of which is entirely submerged when the liquid level is six (6) inches above the bottom of the container. A gasoline storage tank with a capacity of 2,000 gallon or less, installed prior to July 1, 1975, and equipped with a permanent submerged fill pipe, is exempt from Phase I vapor recovery system requirement.
g) Offset Permanent Submerged Fill Pipe – An offset fill pipe is defined as any fill pipe, the discharge opening of which is entirely submerged when the liquid level is 18 inches above the bottom of the container, which is loaded from the side. A gasoline storage tank installed prior to July 1, 1975 and equipped with an offset fill pipe and a permanent submerged fill pipe, is exempt from Phase I vapor recovery system requirement.
h) Date of installation of the tank – The date the tank was installed at the location.
Northern Regional Office * 4800 Enterprise Way* Modesto, California 95356-9322 * (209) 557-6446 * FAX (209) 557-6475
Central Regional Office * 1990 East Gettysburg Avenue * Fresno, California 93726-0244 * (559) 230-5888 * FAX (559) 230-6061
Southern Regional Office * 34946 Flyover Court * Bakersfield, California 93308 * (661) 392-5665 * FAX (661) 392-5585
PA-2
Revised: February 14, 2012