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WATER RESOURCES CONTROL b-PiARD STATE OF CALIFORNIA,_ Z FORM 18, UNDERGROUND UNDERGROUND STORAGE TANK PROGRAM � Ic TANK TANK PERMIT APPLICATION INFORMATION ❑T PERMANENTLY CLOSED TANK COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION NFOgMr OOR EACH TANK. 3 RENEWAL PERMIT 6 TEMPORARY TANK CLOSURE ❑B TANK REMOVED ❑ 1 NEW PERMIT ❑ ❑ NO ❑ MARK ONLY ❑2 INTERIM PERMIT ❑4AMENDED PERMIT FARMTANK-YES 00 ONE ITEM 1 N• �,- O' FACILITY/SITE NAME WHERE TANK IS INSTALLED: SO SPECIFY 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN- B MANUFACTURED BV'. A. OWNERS TANK ID# D. TANK CAPACITY IN GALLONS: C.YEAR INSTALLED 3 DIESEL IF(A,1),IS MARKED,COMPLETE ITEM C.IF(A.T),IS NOT MCRKE❑D,1 UNLEAADEE ITEM 2 LEADED It. TANK CONTENTS B. ❑5 JET FUEL ❑6 AVIATION GAS A. ❑ 1 MO TOR VEHICLE FUEL ❑2 PETROLEUM [:]1 PRODUCT E]4 GASAHOL ❑3 CHEMICAL PRODUCT [:]401L 95 UNKNOWN E]2 WASTE ❑7 METHANOL ❑99 OTHER(DESCRIBE IN REM D.BELOW) ❑ 5 HAZARDOUS E]80 EMPTY ❑ CA.S.#: ,ENTER O OF HA ARDOUS SUBSTIANCE STORED A C.A.S.# III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C.✓k 0 ❑95 UNKNOWN A TYPE OF E] I DOUBLE WALLED ❑3 SINGLE WALLED WITH DOERIOR LINER ❑ ❑ /SECONDARYCONTAINMENT ❑W OTHER SYSTEM 2 SINGLEWALLEO ❑ ❑ 2 STAINLESS STEEL ❑3FIBERGU55 ❑4STEEL CLAD WIFlBERGIASS REINFORCED PLASTIC B.TANK ❑1 STEEUIMN 6 CONCRETE ❑6 POLYVINYLCHLORIDE ❑7 ALUMINUM ❑6100%MEIFIANOL COMPATIBLE FRP MATERIAL ❑9 BRONZE ❑10 GALVANIZED STEEL ❑95 UNKNOWN El 99 OTHER ❑1 RUBBER UNED ❑2 ALKYD LINING ❑3 EPDXY UNING 4 PHENOLIC LINING C LINING F-15 GLASS LINING ❑6 UNLINED 95 UNKNOWN ❑ ISUNING MATERIAL COMPATIBLE WITH IOD%METHANOL? YES ❑ NO 99 OTHER D. CORROSION ❑ I POLYEfHLENEWRAP ❑2 TAR OR ASPHALT ❑ 3 VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, 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 U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FISERGLASSPIPE A U 9/ NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U T STEELCLADW/FRP A U 8 100%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 8 1 VISUALCHECK P S 2 INVENTORY RECONCILIATION P S 3VADOSEWELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUNDWATER MONITORING WELLS P S 6 PRECISION TESTING P 8 ? PRESSURE TESTING P S 91 NONE P 8 95 UNKNOWN P S 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1.ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY Of 3.WAS TANK FILLED WITH SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? [:]YES ❑NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. APPLICANTS NAME(PRINTED 6 SIGNATURE)) DATE LOCAL AGENCY USE ONLY COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# / 1 7ao CURRENT LOCAL AGENCY FACT TY ID# APPROVED BY ME PHONE N WITH AREA CODE L 5l� . Il/ PERMIT NUYBEq PERMIT APPROVAL DATE PERMIT E%PIR TION DATE W CHECKN PERMIT AMOUNT SURCHARGE AMT. FEE CODE RECEIPTk BY: FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE APPLICATION, FORM'A',UNLESS A CURRENT FORMA' HAS BEEN FILED DATA PROCESSING COPY