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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD FORM 'S': UNDERGROUND STORAGE TANK PROGRAM TANK TANK PERMIT APPLICATION INFORMATION ' COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. MARK ONLY ❑ 1 NEW PERMIT ❑3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED TANK ONE ITEM ❑2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ❑8 TANKREMOVED (Dq FACILITY/SITE NAME WHERE TANK IS INSTALLED: BP Chemicals Inc. FARM TANK-YES❑ NO ❑R Z I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY •p A. OWNERS TANK ID# UnknoWnB. MANUFACTURED BY: Unknown C.YEAR INSTALLED 1972 D. TANK CAPACITY IN GALLONS: SOO QD 11. TANK CONTENTS IF(A-1),13 MARKED,COMPLETE ITEM C.IF(0..1),IS NOT MARKED,COMPLETE ITEM D. r A ❑ 1 MOTOR VEHICLE FUEL ❑2 PETROLEUM e. C. ❑ 1 UNLEADED ❑2 LEADED ❑3 DIESEL ❑3 CHEMICAL PRODUCT ❑ 4 OIL ❑ 1PRODUCT ❑4 GASAHOL ❑5 JET FUEL 0 6 AVIATION GAS ❑5 HAZARDOUS 0 80 EMPTY E]95 UNKNOWN ❑2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM 0,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF Not Applicable HAZARDOUS SUBSTANCE STORED 8 C.A.B.# pp GA.&#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A.B,C.A D A TYPE OF ❑ I DOUBLE WALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN SYSTEM ❑2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER ❑X 1 STEELPRON ❑2 STAINLESS STEEL ❑3.FIBERGLASS ❑4 STEELCIAD W/FIBERGLASS REINFORCED PLASTIC B.TANKF-1 5 CONCRETE ❑6 POLYVINYLCHLORIDE F-17 ALUMINUM ❑8100%METHANOL COMPATIBLE FRP MATERIAL [:]9 BRONZE ❑10 GALVANIZED STEEL ❑95 UNKNOWN ❑99 OTHER G INTERIOR F-11 RUBBER UNED ❑ KYD 2 ALUNING F-13 EPDXY UNING ❑4 PHENOLIC LINING LINING ❑5 GLASS LINING ❑X 6 UNLINED ❑95 UNKNOWN ❑ IS LINING MATERIAL COMPATIBLE WITH 100%MEDIANOL? ❑YES ❑NO ❑99 OTHER D. CORROSION ❑ 1 POLYETHLENE WRAP L.1GI 2 TARORASPHALT ❑3 VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION 5 CATHODIC PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A FABOVEGROUND, U IF 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 � 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASSPIPE A U 91 NONE C.MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELCLADW/FRP A U 8 100%METHANOL COMPATIBLE FRP A U 9 GALVANIZEDSTEEL A U 95 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. 8 1 VISUAL CHECK P S 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P 8 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P SAZNONE P 8 95 UNKNOWN P S 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE I Not Applicable 1.ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED OUANTITY OFGILLLONB 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN INERT MATERIAL? E]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 8 SIGGNNLIFE) DATE B. Swearingen VJ 2-5-90 LOCAL AGENCY USE ONLY IY CO�UNTYY## JURISDICTION# AGENCY# FACILITY ID# TANK ID# CURRENT LOCAL AGENCY FACILITY IDN APPROVED BY NAME PHONE#WITH AREA CODE 503 z1 :3171'-1d PERMIT NUMBER PERMIT APPROVAL DATE PERMIT 9XPIhATION DATE CMECK0 PERMIT AMOUNT SURCHARGEAMT. FEE CODE -cCEIPT# BY: -`-� FORM 8(6-29-88) THIS FORM MUST BE ACCOMPANIEU BY A FACILITY/SITE APPLICATION, FORM 'A',UNLESS AZTRRENT FORMA' HAS BEEN FILED DATA PROCESSING COPY