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YJu^C� STATE OF=FORNIA s"••••; v� STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR H TANK SYSTEM. MARK ONLY ❑ t NEW PERMIT ❑ 3 REN>:WAL PERMIT 5 CHANGE OF INFORMATION ❑ PERMANENTLY CLOSED ON ITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 0 TEMPORARY TANK CLOSURE g TANK AEMOV 0 08A OR FACILITY NAME WHERE TANK IS�IN-7S�T u0i 1. TANK DESCRIPTION coMpLef DLL EMS— SPECIFY IF UNKNOWN ' A. OWNERS TANK I.D.S 8. MANUFACTURED 8Y: 1 C. DATE INSTALLED(MORAYIYEAR) 0. TANK CAPACITY IN GAL ONS: } IL TANK CONTENTS IFA.IISMARKED.COMPT6 ITEM C. A. ❑ 1 MOTOR VEHICLE FUEL a OIL g C. ❑ IRREGULAR ` 3 DIESEL �j� AVIATION AS' UNLEADED uu ❑ 2 PETROLEUM ❑ So EMPTY ❑ I.,PAODUCT ❑ lb bIPREMIU S EL ❑ 7'METHANOL I ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN 2 WASTE ❑ 2 LEADED OTHER (DESCRIBE IN ITEM 0. BELOW) D. IF(A.:)IS NOT MARK^c0. ENTER NAME OF SUBSTANCE STORED S ' I 9O/ t 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BoxES A.B.AND C,AND ALL TWAT APPLIES IN BOX D f � A. TYPE OF ❑ DOUBLE WALL ❑ 3 SINGLE WALL wrrH EXTERIOR LINER ❑ Ss uNKNO N SYSTEM 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER i B. TANK C] 1 BARE STEEL ❑ 2 STAINLESS STEEL C33 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ S CONCRETE ❑ B POLYVINYL CHLORIDE ❑ 7 UMINUM ❑ g roar. METHANOL COMPATIBLE w,FAP (Primary Tank) El9 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN ❑ 99 OTHER 1 ❑ I RUBBER LINED ❑ 2 ALKYD LINING �PDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ S GLASS LINING ❑ d UNLINED ��L,,'/95 UNKNOWN ❑ 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO,_,_ D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑��5 WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE UNKNOWN ❑ 99 OTHER 1V.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U SFUNOERGFtOUND.20THIFAPPLtCABLE A. SYSTEM TYPE A U I 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 A U 95 UNKNOWN€ A U 99 OTHER 1 C. MATERIAL AND A U t BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE{PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U b CONCRETE A U 7 STEEL WI COATING A U 2 100% METHANOL COMPATIBLE WIFRP r PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHCOIC PROTECTION A U 95 UNKNOWN A U 99 OTHER f D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING 03 ,14 +I IAL ❑ s9 OTHER VCNIr0AING V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING ❑ B TANK TESTING ❑ 7 INTERSTITIALMONITowNa ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1,ESTIMATEO CATE LAST USED(MOIDAYNR) 2.ESTIMATED QUANTITY OF SUBSTANCE REMAINING 3 WAS TANK FILLED WITH ❑ NO❑ GALLONS INERT 51ATEALAL 1 THIS FORM HAS BEEN COMPLE;ED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME GATE '€ {PFLr€Y£p 4 StGNANR>ry Z-7 LOCAL AGENCY USE ONLY THE S AT L0.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW / 1 ( i &/ /COUNTY x sUR 5DICT10N to FACILITY# TANK.* STA E i.D.# d fl' (J C� f' O PErZMITNUMBEA P£AMiTAP ApVEDBY/OATE - P RMlrEXPIRATIONOATE 1 r FORM 8 (9.90) THIS FORM MUST 8E A,iCOMP, PERMIT APPLICATION•FORM A,UNLESS A CU ENT FORM A HAS BEEN FILED 4r FOR0=8-44