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I a STATE OF CALIFORNIA • STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM BCOMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. � MARK ONLY ❑ 1 NEW PERMIT ❑ ONE ITEM ❑ 2 INTERIM PERMIT ❑ 3 RENEWAL PERMIT 4 AMENDED PERMIT ❑ 5 CHANGE OF INFORMATION `-❑ ❑ 6 TEMPORARY TANK CLOSURE 7 PERMANENTLY CLOSED ON SITE ❑ B TANK REMOVED / z DBA OR FACILITY NAME WHERE TANK IS INSTALLED: <l I/ ❑ 95 UNKNOWN SYSTEM I TAuv nrnnn 14 I^LI C.A.S.#: ❑ 99 OTHER B. TANK wMFLt 1 t ALL I I LNIb -- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# Cj / B. MANUFACTURED BY: vN L un C. DATE INSTALLED (MC/DAY/YEAR) D. TANK CAPACITY IN GALLONS: y w // m u II. I MIrn uviv l Ell I J IFA -1 IS MARKED, COMPLETE ITEM A. /� 1 MOTOR VEHICLE FUEL ❑ 4 OIL ❑ 2 PETROLEUM ❑ 80 EMPTY ❑ 3 CHEMICALPRODUCT ❑ 95 UNKNOWN D. IF (A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED B. � PRODUCT ❑ 2 WASTE C. ❑ 18REGULAR UNLEADED ❑ lb PREMIUM UNLEADED 1 y9 T LJ 3 DIESEL ❑ 6 AVIATION GAS H 4 GASAHOL ❑ 7 METHANOL ❑ 5 JETFUEL ❑ 99 OTHER (DESCRIBE IN ITEM D. BELONG ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM SINGLE WALL C.A.S.#: - -•••••••••�•• _.._..........-•, ,,. •,.,.�....., ..�.� ALL 1 nA I ArrLItS In 6UA U A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTEDTANK) ❑ 99 OTHER B. TANK �� LTJ ' BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/ FIBERGLASSREINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE (Primary Tenk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN W/FRP ❑ 99 OTHER C. INTERIOR ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING LINING F-]5 GLASS LINING ❑ 6 UNLINED UNKNOWN ❑ gg OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO— D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑•95 UNKNOWN ❑ 99 OTHER 11/ of orun_Ir.lenou.rina --------- -•••••••••�•• 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING ❑ 4 AUTOMATIC TANK GAUGING -.—L=MmAevveunuunu un u IF UNDERGROUND, BOTH IF APPLICABLE ❑ 6 TANK TESTING A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH ISD 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION A U A U A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 10D% METHANOL COMPATIBLE W/FRP 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A095 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR O 2 LINE TIGHTNESS TESTING3INTERSTITIAL .-- ❑ MONRORING ❑ 99 OTHER V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING ❑ 6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER 1. Inlrn VLVJVn G l lvrunwiFt I IUPI 1. ESTIMATED DATE ST USD(MO/aDA�R1 2. ESTIMATED QUANTITY OF 3.WASTANKFILLED WITH '' 11 SUBSTANCE REMAINING GALLONS INERT MATERIAL I YES ❑ NO THIS FORM HAS RFFN CnAAPI FTcn nunco ocuAl , — ..._ _- _.._ --__ - LOCA - ---- •- •••-L••-L•• ..1 ml nlvvvvLcuUt, /J' IHUr ANO COF APPLICANTS NAME (PAINTED B SIGNATURE) DATE L1.r,1 VJLVIYLI IntsIAItI.U.NUMdEHISCOMPOSED OFTHEFOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY# TANK # STATE LDAS i PERMIT NUMBER PER MIT APPROVED BY/DATE PERMIT EXPIRATION DATF-r p 1 ]RM THIS FORM MI ICT RF ArM ECT -------- •-•........ PUHMA HASBEENFILED. PO RO9W&R4 S