Fillable Form 400-PS.: Storage Tank Section A - Operator (SCAQMD)

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Form 400-PS.: Storage Tank Section A - Operator (SCAQMD)

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South Coast Air Quality Management District, Form 400-E-18 (2014.07)
Mail To:
SCAQMD
P.O. Box 4944
Diamond Bar, CA 91765-0944
Tel: (909) 396-3385
www.aqmd.gov
South Coast Air Quality Management District
Form 400-E-18
Storage Tank
This form must be accompanied by a completed Application for a Permit to Construct/Operate - Forms 400-A, Form 400-CEQA, and
Form 400-PS.
Page 1 of 3
Section A - Operator Information
Facility Name (Business Name of Operator That Appears On Permit): Valid AQMD Facility ID (Available On Permit Or Invoice Issued By AQMD):
Address where the equipment will be operated (for equipment which will be moved to various locations in AQMD’s jurisdiction, please list the initial location site):
Fixed Location Various Locations
Tank Type
(Select ONE)
External Floating Roof Tank (EFRT) Internal Floating Roof Tank (IFRT) Horizontal Tank (HT)
Vertical Fixed Roof Tank (VFRT) Domed External Roof Tank (DEFRT)
Identification
Tank Identification Number: Tank Contents/Product (include MSDS):
Shell Diameter (ft.):
Is Tank Heated?
Yes No
Number of Columns?
External Shell Condition:
Good
Poor
Average Liquid Height (ft.)
(Vertical Only):
Paint Condition:
Good
Poor
Shell Length (ft.):
Is Tank Underground?
Yes No
Effective Column Diameter:
9” by 7” Built Up Column - 1.1
Internal Shell Color:
Light Rust
Dense Rust
Gunite Lining
Maximum Liquid Height (ft.)
(Vertical Only):
Paint Color/Shade:
White/White
Aluminum/Diffuse
Shell Height (ft.):
Net Throughput (gal/year):
8” Diameter Pipe - 0.7
External Shell Color:
White/White
Aluminum/Specular
Aluminum/Diffuse
Working Volume (gal.)
(Vertical Only):
Gray/Light
Aluminum/Specular
Turnovers Per Year:
Self Support Roof:
Yes No
Unknown - 1
Gray/Light
Gray/Medium
Red/Primer
Actual Volume (gal.)
(Vertical Only):
Gray/Medium
Red/Primer
Roof Type:
Pontoon
Double Deck
Roof Paint Condition:
Good
Poor
Dome Roof (Height
ft.)
Cone Roof (Height
ft.)
Roof Color/Shade:
White/White
Aluminum/Diffuse
Roof Fitting Category:
Typical
Detail
Gray/Light
Aluminum/Specular
Roof Height (ft.):
Gray/Medium
Red/Primer
Deck Type:
Welded Bolted
Construction: Deck Seam Length (ft.): Deck Seam:
Sheet
5 ft. wide 6 ft. wide 7 ft. wide
Deck Fitting Characteristics:
Typical Detailed (Complete Deck Seam)
Panel
5 x 7.5 ft. 5 x 12 ft.
Tank Construction:
Welded
Riveted
Primary Seal:
Mechanical Shoe
Vapor Mounted
Liquid Mounted
Secondary Seal:
Rim Mounted None
Shoe Mounted
Section B - Tank Information
Tank Characteristics
Roof Characteristics
(Floating Roof Tank)
Deck Characteristics
(Floating Roof Tank)
Tank Construction and Rim
-Seal System
(Floating Roof Tank)
Breather Vent Setting
Vacuum Setting (psig): Pressure Setting (psig):
* Section D of the application MUST be completed.
South Coast Air Quality Management District, Form 400-E-18 (2014.07)
Mail To:
SCAQMD
P.O. Box 4944
Diamond Bar, CA 91765-0944
Tel: (909) 396-3385
www.aqmd.gov
South Coast Air Quality Management District
Form 400-E-18
Storage Tank
This form must be accompanied by a completed Application for a Permit to Construct/Operate - Forms 400-A, Form 400-CEQA, and
Form 400-PS.
Page 2 of 3
Section B - Tank Information (cont.)
Site Selection
Nearest Major City:
Daily Average Ambient Temperature (
˚F ): Annual Average Minimum Temperature (˚F):
Annual Average Maximum Temperature (
˚F ): Average Wind Speed (mph):
Annual Average Solar Insulation Factor ( Btu / (ft
3
* ft * day) ):
Tank Contents
Chemical Category: Organic Liquids Crude Oil Petroleum Distillates
Liquid: Single Multiple
If Multiple, Select Speciation Option: Full Speciation Partial Speciation
Various Weight Speciation None
Number Pressure Setting Vaccum Setting
Atmosphere Vapor Control Flare
Combination
Pressure
Vaccum
Open
Discharging to (Check Appropriate Box)
Section C - Operation Information
Vapor Control
Vapor Control During Loading or Unloading: Sparger Vapor Balance System Vapor Return Line
Vented to Air Pollution Control Equipment
1
1
A separate permit is required. If APC equipment is already permitted, provide Permit or Device Number:
Vent Valve Data
Indicate Type of Setting and Vapor Disposal
Materials
Name all liquids, vapors, gases, or mixtures of such material to be stored in this tank:
If material is stored in a solution, supply the following information:
Name of Solvent:
Name of Materials Dissolved:
Concentration of Materials Dissolved:
% by Weight OR % by Volume OR lbs/gal
Section D - Roof/Deck Fitting
Roof/Deck Fitting Details
1. Access Hatch (24” diameter well) 2. Automatic Gauge Float Well 3. Column Well (24” diameter well)
(20” diameter well)
Bolted Cover, Gasketed Bolted Cover, Gasketed Built-Up Col - Sliding Cover, Gasketed
Unbolted Cover, UnGasketed Unbolted Cover, Ungasketed Built-Up Col - Sliding Cover, Ungasketed
Unbolted Cover, Gasketed Unbolted Cover, Gasketed Pipe Col - Flex, Fabric Sleeve Seal
Pipe Col - Sliding Cover, Gasketed
Pipe Col - Sliding Cover, Ungasketed
Section D is required for the following tanks: External Floating Roof Tank, Internal Floating Roof Tanks, or Domed External Floating Roof Tanks.
Select the number of fittings for each applicable question. Examples: 3
Unbolted Cover, Ungasketed
Unbolted Cover, Gasketed
South Coast Air Quality Management District, Form 400-E-18 (2014.07)
South Coast Air Quality Management District
Form 400-E-18
Storage Tank
This form must be accompanied by a completed Application for a Permit to Construct/Operate - Forms 400-A, Form 400-CEQA, and Form 400-PS.
Page 3 of 3
THIS IS A PUBLIC DOCUMENT
Pursuant to the California Public Records Act, your permit application and any supplemental documentation are public records and may be disclosed to a third party. If you wish to
claim certain limited information as exempt from disclosure because it qualifies as a trade secret, as defined in the District’s Guidelines for Implementing the California Public Records
Act, you must make such claim at the time of submittal
to the District.
Check here if you claim that this form or its attachments contain confidential trade secret information.
4. Gauge Hatch/Sample Well (8” diameter well)
Weighted Mechanical Actuation, Gasketed
Weighted Mechanical Actuation, Ungasketed
6. Rim Vent (6” diameter)
Weighted Mechanical Actuation, Gasketed
Weighted Mechanical Actuation, Ungasketed
8. Roof Leg (3” diameter leg)
Adjustable, Pontoon Area, Ungasketed
Adjustable, Center Area, Ungasketed
Adjustable, Double-Deck Roofs
Fixed
Adjustable, Pontoon Area, Gasketed
Adjustable, Pontoon Area, Sock
Adjustable, Center Area, Gasketed
Adjustable, Center Area, Sock
5. Ladder Well (36” diameter)
Sliding Cover, Gasketed
Sliding Cover, Ungasketed
7. Roof Drain (3” diameter)
Open
90% Close
9. Roof Leg or Hang Well
Adjustable
Fixed
10. Sample Pipe (24” diameter)
Slotted Pipe – Sliding Cover, Gasketed
Slotted Pipe – Sliding Cover, Ungasketed
Slit Fabric Seal, 10% Open
11. Guided Pole/Sample Well
Ungasketed, Sliding Cover, Without Float
Ungasketed Sliding Cover, With Float
Gasketed Sliding Cover, Without Float
Gasketed Sliding Cover, With Float
Gasketed Sliding Cover, With Pole Sleeve
Gasketed Sliding Cover, With Pole Wiper
Gasketed Sliding Cover, With Float, Wiper
Gasketed Sliding Cover, With Float, Sleeve, Wiper
Gasketed Sliding Cover, With Pole Sleeve, Wiper
12.
Stub Drain (1” diameter)
13. Unslotted Guide – Pole Well
Ungasketed, Sliding Cover
Gasketed Sliding Cover
Ungasketed Sliding Cover with Sleeve
Gasketed Sliding Cover with Sleeve
Gasketed Sliding Cover with Wiper
14. Vacuum Breaker (10” diameter well)
Weighted Mechanical Actuation, Gasketed
Weighted Mechanical Actuation, Ungasketed
Section D - Roof/Deck Fitting (cont.)
Roof/Deck Fitting Details
(cont.)
Section D - Authorization/Signature
I hereby certify that all information contained herein and information submitted with this application is true and correct.
Preparer
Info
Signature: Date:
Title: Company Name:
Name:
Phone #: Fax #:
Email:
Contact
Info
Name:
Title: Company Name:
Phone #: Fax #:
Email:
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Form 400-PS.: Storage Tank Section A - Operator (SCAQMD)

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Completed 12 August 2020

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