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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD <br />FORM'B': UNDERGROUND STORAGE TANK PROGRAM <br />TANK TANK PERMIT APPLICATION INFORMATION <br />COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. <br />MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWALPERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLYCLO ED TANK <br />ONE ITEM ❑ 2INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE 1:18 TANK REMOVED D -I <br />FACILITY/SITE NAME WHERE TANK IS INSTALLED: FARM TANK - YES ❑ NO <br />1. TANK DESCRIPTION COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY <br />A. OWNERS TANK ID# N No VV <br />B. MANUFACTURED BY: OI JKNOW#✓ <br />C. YEAR INSTALLED V ! V)i <br />