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STATE OF CALIFORNIA WATER RESOURCES CONTROI -OARD FORM `B': UNDER;ROUND STORAGE TANK PROD-AAM TANK TANK PERMIT APPLICATION INFORMATION (aCOMPLETE A SEPARATE FORM WITH THE FOLLOWING 1 ORMATION FOR EACH TANK. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED TANK FO ONE ITEM ❑ 2INTERIM PERMIT ❑ 4 AMENDEDPERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED �..� FACILITY/SITE NAME WHERE TANK IS INSTALLED: Ire JU FARM TANK-YES❑ NO N i✓ I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY p A. OWNERS TANK IDa 8. MANUFACTURED BY: ik C. YEAR INSTALLED ct K 1 D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A. ❑ 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM B. C. ❑ 1 UNLEADED ❑2 LEADED ❑3 DIESEL F-1 3 CHEMICAL PRODUCT OIL 1 PRODUCT ❑4 GASAHOL ❑5 JET FUEL ❑6 AVIATION GAS ❑5 HAZARDOUS ❑80 EMPTY [:] 95 UNKNOWN ❑2 WASTE ❑ 7 METHANOL ❑99 OTHER(DESCRIBE IN REM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF O (Y HAZARDOUS SUBSTANCE STORED&C.A.S.R C.A.S.N. a III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOK A,B,C,&D A. TYPE OF ❑ 1 DOUBLE WALLED ❑ SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN SYSTEM ❑2 SINGLE WALLED ❑/ ONDARY CONTAINMEM ❑99 OTHER ❑ 1 STEBUIRON ❑2 INLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B. TANK ❑5 CONCRETE ❑6 POE INYL CHLORIDE ❑7 ALUMINUM ❑S 10996 METHANOL COMPATIBLE FRP MATERIAL ❑9 BRONZE ❑ 10 GALV IZEDSTEEL ❑ 95 UNKNOWN 99 OTHER ❑ 1 RUBBERLINED ❑ 2 ALKYD G F-13 EPDXY LINING ❑4 PHENOLIC LINING C. INTERIOR LINING 5 GLASS LINING fi UNLINED ❑95 UNKNOWN ❑ ❑ ❑ IS LINING MATERIAL COMPATIBLE WITH 100%METHAN ? ❑YES ❑ NO ❑99 OTHER D. CORROSION ❑ I POLYETHLENE WRAP ❑2 TARORASPHALT ❑3 WNYLWRAP ❑4 FIBERGLASS REINFORCED RASRC PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE ❑95 UNKNOWN ❑W OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U F UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESSSTEEL U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELCLADW/PRP A U 8100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR 8 FORS ONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P S 1 VISUAL CHECK P 8 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE S 95 UNKNOWN P 8 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLA 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH to- OAlLONB SUBSTANCE REMAINING IN INERT MATERIAL? ❑YES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. APPLICANT'S NAME(PRINTED&SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY k JURISDICTION N AGENCY k FACILITY ID R TANK ID N / I= CURRENT L AL AGENCY FACILITY ID• APPROVED BY N M �pLhrPHONE N WITH AREA CODE 471 PERMIT NUMBER S PERMIT APPROVAL DA PERMIT EXPIRATION DATE CHECK M PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPT F BY: FORM B(6-2988) THIS FORM MUST BE ACCOMPANIED _ iACILITY/SITE APPLICATION, FORM 'A',UNLESS A Cl NT FORMA' HAS BEEN FILED )ATA FK::LSStN:> CUP':