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04/26/1999 07:11 7146705420 EHS ARCO LA PALMA PAGE 04 STATE Of CALIFONOA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B : �_- ' "' COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY Ej 1 NEW PERMIT ❑ 3 RENEWAL PERMIT S CHANGE OF INFORMATION ❑ PERMANENTLY CLOSED CN SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE TANK REMOVED DBA OR FACILITY NAME WHERE TANK 1S INSTALLED: py��,p 'r%L ti10. Lqq 1. TANK DESCRIPTION COMPLETE ALL ITEMS SPECIFY IF UNKNOWN A. OWNER'S TANK L D.a Z_V L�-� B. MANUFACTURED BY! C. DATE INSTALLED(MO/DAYNEAR) 1Z 8 D. TANK CAPACITY IN GALLONS; 11.TANK CONTENTS IFA-I IS MARKED,COMPLETE ITEM C. A. L� MOTOR VEHICLE FuEL ❑ 4 .OIL g C L�( to REGU!AR 3 DIESEL UNLEADED —� 6 AVIATION GAS 2 PETROLI=UM ❑ 80 EMPTY PgODUCT ❑ 1bpREM1UM 4 13ASAHOL I UNLEADED 5 JETFUEL ❑ 7 METHANOL [] 3 CHEMICAL PRODUCT ❑ 96 UNKNOWN ❑ 2 WASTE 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM O. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED —' C.A.S.a; 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A:B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL. WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEMJ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER_ 8. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL [jj� FIBERGLASS ❑ 4 STEEL,CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL f_ a 6 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 0 100% METHANOL COMPATIBLE WiPRP (FrlmaryTank) j 9 13RONZE ❑ 10 QALVAN¢ED STEEL ❑ US UNKNOWN ❑ g9 OTHER ❑ 1 RUBBER BER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LININQ_� C,INTERIOR Ca 5 GLASS LINING NG ❑yes UNLINED ❑ 95 UNKNOWN ❑ SB OTHER IS LINING MATERIAL COMPATIBLE WITH 1009E METHANOL? YES, NO— D.CORROSION YIN'❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP Ej�q FIBERGLASS REINFORCED PLASTIC PROTECTION 1 5 CATHODIC PROTECTION ❑ 91'.NONE ❑95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV,PIPING INFORMATION CIRCLE A IF ABOVEI3ROUNDOR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE _ A U 1 SUCTION AQ 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION 701 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH p U 45 UNKNOWN A U 99-OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESB STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U d FIBERGLASS PIPE ^ CORROSION A U 9 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U B IDD% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 93 UNKNOWN A U 99 OTHER D. LEAK DETECTION / AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING ❑ 3 MONITORING [:]99 OTHER V.TANK LEAK DETECTION VISUAL CHECK [❑ 7. INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITCRING 1 L�re TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED QA F LAS USED(MO/DAYNR) Z ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH tri SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 YES ❑ NC ❑il THIS FORM HA BEEN COMPLETED UNDER PENALTY OF RJ PY,AND TO TWE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME DATE (PRINTED A 8I0NA7UpF //'7//� - 7 C_ LOCAL AGENCY USE ONLY THE STATE LD,NUMBER IS C OSED OFTHE FOUR NUM RS BELOW STATE LD.# COUNTY# JURI ICTION X FACILITY v TANK# ❑❑ PEr1Mir NUMBEq PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (7.91) THIS FORM MUST HE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORa¢748-R,5