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04/26/1999 07: 11 7146705420 EHS ARCO LA PALMA PAGE 03' <br /> STATE OFCALIFORNIA ' o, <br /> STATE WATER RESOURCES CONTROL BOARD <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B K a <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, <br /> MARK ONLY F'j 1 NEW PERMIT3 RENEWAL PERMIT 5 CHANGE OF INFORMATION a PERMANENTLY CLOSED ON,. <br /> BITE <br /> ONE ITEM IwJ 2 INTERIM PERMIT a AMENDED pf=KNIT O 8 TEMPORARY TANK CLOSURE TANK REMOvE❑ <br /> DBA OR FACILITY NAME WHERE TANK 13 INSTALLED: RP O FR(_ Jap L4 9 3Z <br /> I. TANK DESCRIPTION COMPLETH ALL ITEMS-- SPECIFY IF UNKNOWN <br /> A. OWNER'S TANK I.D.s I U1Jlr_ <br /> Q B. MANUFACTURED BY: V 1,1�A'�'lOw Jj <br /> C. DATE INSTALLED(MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: <br /> ! <br /> ILTANKCONTENTS )FA-iISMARKED,COMPLETE ITEM C. <br /> A, C MOTOR VEHICLE FUEL 4 OIL I gC. 2111 REGULAR 3 DIESEL <br /> UNLEADED L_J 8 AVIATION GAS <br /> 2 PETROLEUM � W EMPTY i 1 1 PRODUCT [1] 1b PREMIUM 4 GASAHOL <br /> 7 METHANOL <br /> UNLEADED 5 JETFUEI, <br /> 3 CHEMIOAL PRODUCT 95 UNKNOWN 12 WASTE 1 2 LEADED <br /> F7 99 OTHER (DESCRIBE IN ITEM 0. BELOW1 <br /> D. fF(A.1)IS NOTMARKEO, ENTER NAME OF SUBSTANCE STORED — —. <br /> -- <br /> III. TANK CONSTRUCTION MARK ONC ITEM ONLY IN BOXES A,9,AND C,AND ALL THAT APPLIES IN BOX D AND E <br /> A. TYPE of �� <br /> DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER =195 UNKNOWN <br /> I. <br /> SYSTEM _ F;?-*'2 SINGLE WALL a 4 SECONDARY CONTAINMENT (VAULTEDTANK) E:l 99 OTHER <br /> CJ 2 STAINLESS STEEL ` <br /> B. TANK 1 BARE STEEL O 1?­5 FIBERGLASS a 4 STEEL CLAD W/FIBERGLASS.REINFORCED-LASTIC <br /> MATERIAL 5 CONCRETE 6 POLYVINYL CHLORIDE 7 ALUMINUM = 8 100% METHANOL COMPATIBLE W/FRP <br /> (PrlmanyTank) 9 BRONZE O 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER_ <br /> C� 1 RUBBER LINED 2 ALKYD LINING <br /> CINTERIOR 3 EPDXY LINING 4 PHENOLIC LINING <br /> -� <br /> , 5 GLASS LINING <br /> LIMING 0 Ej�UNLINED 95 UNKNOWN p9 OTHER <br /> M <br /> IS <br /> LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES^ NO_ <br /> O.CORROSION -J 1 POLYETHYLENE WRAP 2 COATING 3 VINYL WRAP l " FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION S CATHODIC PROTECTION Q 91 NONE 95 UNKNOWN UJ 99 OTHER <br /> E.SPELL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A. SYSTEM TYPE A U 1 SUCTION A® 2 PRESSURE A U 3 GRAVITY A U 99 OTHER <br /> B. CONSTRUCTION A(2) 1 SINOLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH --"� <br /> -- ^� A U 95 UNKNOWN A U 99 OTHER <br /> C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A0 4 FIBERGLASS PIPE M <br /> CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING <br /> PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION 95 UNKNOWN A U 8 100% METHANOL COMPATIBLE w/FRP <br /> ---.---. A U A U gv OCHER <br /> D. LEAK DETECTION LJ 1 AUTOMATIC LINE LEAK DETECTOR 2 UNE T GHTNESS TESTING � TEfi$ r <br /> MONfi0RIN6 '.�J 99 OTHER <br /> V,TANK LEAK DETECTION -- <br /> I rl VISUAL CHECK �� 2 INVENTORY RECONCILIATION 3 VADOZE MONITORING a 4 AUTOMATIC TANK GAUGING 5 GROUND WATER MONITORING <br /> _6 TANK TESTING 7 INTERSTITIAL MONITORING a 81 NONE J 99 UNKNOWN 99 OTHER <br /> VL TANK CLOSURE INFORMATION <br /> 1.ESTIMATE)D TE LAPT USED(MOIDAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH ( l �-Imo'y <br /> /U SUBSTANCE REMAINING GALLONS NERT MATERIAL 7 YES � NO <br /> THIS FORM H S BEEN COMPLETED UNDER PENALT"F P PJURY,A D TO TRE BEST OF MY KNOWLEDGE, /S TRUE AND CORPF_CT <br /> APPLICANTS NAME <br /> SPRINTED&SIGNATURE) �j)f l / L / GATE <br /> LOCAL AGENCY USE ONLY THE STATE 1,D.NUMBER COMPOSED OF THE FOUR N BERS BELOW <br /> COUNTY# JURISDICTION g FACILITY A TANK# <br /> STATE I.D,# � � <br /> PERMIT NUMBER PERMIT APPROVED HY/DATE <br /> PE RM IT EXPIF2ATION DATE <br /> FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. <br /> FDROS3a8Rs <br />