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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD FORM BH: UNDERGROUND STORAGE TANK PROGRAM TANKTANK PERMIT APPLICATION INFORMATION ' COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. - MARK ONLY ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT ❑5 CHANGE OF INFORMATION ❑7 PERMANENTLY CLOSED TANK ONE ITEM ❑2 INTERIM PERMIT ❑A AMENDED PERMIT 6 TEM TANK CLOSURE 6 TANK REMOVED A;zFACILITY/SITE NAME WHERE TANK IS INSTALLED: Stockton Plating Inc . FARM TANK-YES❑ NO X 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY A. OWNERS TANK IDK I B. MANUFACTURED BY Unknown C. YEAR INSTALLED Unknown 10. TANK CAPACITY IN GALLONS'. 11. TANK CONTENTS IF(At),IS MARKED,COMPLETE ITEM C.IF(A1),IS NOT MARKED,COMPLETE ITEM D. A. ® I MOTOR VEHICLE FUEL ❑2 PETROLEUM B. C. ® 1 UNLEADED ❑2 LEADED ❑3 DIESEL ❑3 CHEMICAL PRODUCT ❑J OIL ®1 PRODUCT ❑A GASAHOL ❑5 JET FUEL ❑6 AVIATION GAS ❑5 HAZARDOUS ❑BO EMPTY ❑95 UNKNOWN ❑2 WASTE ❑7 METHANOL ❑99 OTHER(DESCRIBE IN ITEM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED 8 C A .K C.AS.A: Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A.B.C.A O A TYPE OF ❑ I DOUBLE WALLED ❑3 SINGLE WALLED WITH D%TERIOR LINER ❑95 UNKNOWN SYSTEM ®2 SINGLE WALLED ❑1 SECONDARY CONTAINMENT ❑99 OTHER O I STEELARON ❑2 STAINLESS STEEL ❑3 FIBERGLASS ❑/STEEL CUD W/RBERGUSS REINFORCED KWIC 1.TANK ❑5 CONCRETE ❑6 POLYVINYL CHLORDE ❑ 7 ALUMINUM ❑B IW%MEMANOL COMPATIBLE FRP MATERIAL 9 BRONZE ❑ 10 GALVANIZED STEEL ❑%UHI(NOWN ❑99 OTHER ❑ I RUBBER UNED ❑2 ALL(YD UNING ❑3 EPDXY LINING ❑A PHENOLIC UNING C.NUENTIENRIOR F-15 GLASS LINING ® NLI 6 UNED ❑%mm" ❑IS LINING MATERIAL COMPATIBLE WITH I00%MEMA40L ❑YES ❑NO ❑99 OTHER D.CORROSION ❑ I POLYETHUNE WRAP ®2 TARORASPHALT 3 VWL WFMP ❑K FIBERGLASS REINFORCD PLASTIC PROTECTION 5 CATHODIC PWTECTION ❑91 NONE ❑%UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND. U IF UNDERGROUND,BOTH IF APPLICABLE A SYSTEMTYPE A U I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U M UNKNOWN A U 99 OTHER B.CONSTRUCTION A U I SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U N OTHER AI U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYLCHLORDE(PVC) A U /FIBERGLASS PIPE A U 91 NONE C.MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CUD W/FRP A U 9 11 METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL 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. P E 1VISUAL CHECK IDS 2 INVENTORY RECONCILIATION P S 3VADOSE WELLS P E A ELECTRONIC MONITOR V E 5 GROUND WATER MONITORING WELLS P(805 PRECISION TESTING F 7 PRESSURE TESTING P E 91 NONE P E 95 UNKNOWN P S "OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE t ESTIMATED DATE UST USED(MO/YR) 2 ESTIMATED OUANTITY OFGMLONE 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN INERT MATERIAL ❑YES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENAL F PERJURY,T2 TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. APPLICANT'S NAME(PRINTED 6 SIGNATURE) DATE ^ Robert E . Huntley 4� nDQb LOCAL AGENCY USE ONLY COUNTY F JURISDICTION P AGENCY E FACILITY ID F TANK ID E CURRENT LOCAL AGENCY FACILITY ID F AFFROVED BY NAIVE PHONE E WITH AREA CODE sTp PERMT NUNEER PERYR APMOYAL DATE RRYR EXPIRATION DATE CHECK• noun AMOUNT SURCHARGE AMT. m CODE RECEIPT N BY: FORM B(6-29-M) THIS FORM MUST BE ACCDr'`'D BT A FACSIITIMTE AFS=TIOK FORM'A',LM M P"SSMT FDMI'M IMS SEEN FLED (' 1 VATA-0110CESSING COPY 2 LOCAL AGENCY COP(., 3 fma COPY �/