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04/26/1999 07: 11 7146705420 EHS ARCO LA PALMA PAGE 05 <br /> STATE OF CALIFORNIA <br /> STATE WATER RESOURCES CONTROL BOARD <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B <br /> d . <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, .>�^ <br /> MARK ONLY 1 NEW PERMIT [�] 3 RENEWAL PERMIT CHANGE OF INFORMATION 7 PERMANENTLY CLOSED UN SITE <br /> ONE ITEM 2 INTERIM PERMIT O 4 AMENQED PERMIT L <br /> 8 TEMPORARY TANK CLOSURE TANK REMOVED <br /> DBA OR FACILITY NAME WHERE TANK IS INSTALLED; VZeX.0 Iqe­ t C), t-(932 <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN <br /> A. OWNER'S TANK L D"I <br /> _ B. MANUFACTURED BY: UN 1'C4Qw0 <br /> C. DATE INSTALLED WO�DAYNLAR) I Z I S( D. TANK CAPACITY IN GALLONS; <br /> II.TANKCONTENTS 11=A.1{SMAAKED,COMPLETEITEM C. <br /> A. rµt� MOTOR VEHICLE FUEL 4 OIL g (""`, 1a REGULAR <br /> '=� C. LJ UNLEADED 3 OfESEL r- � AVIATION GAS <br /> _ 1 2 PETROLEUM C 80 EMPTY 7V ' PRODUCT �Ib PREMIUM 4 GASAHOL �. <br /> UNLEADED 5 JET'FUEL <br /> O L,....J' 7 METHANOL <br /> 3 CHEMICAL PRODUCT � 96 UNKNOWN Q 2 WASTE ED 2 LEADED !"u`1 <br /> 99 OTHER (OErSCRIBE IN IYEM D. BELCW) <br /> D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED w--- <br /> C.A.S.s: <br /> III. TANK CONSTRUCTION. MARK ONE(TEM ONLY IN BOXES A,B,AND C,AND ALLTHATAPPLIES IN BOX D AND E <br /> A TYPE OF 1 DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER <br /> �`��/ a 95 UNKNOWN <br /> SYSTEM – 4...:J 2 SINGLE WALL 4 SECONDARY CONTAINMENT (VAULTEDTANK) 99 OTHER _ <br /> B. TANK Y BARE STEEL 2 STAINLESS STEEL [jr3 FIBERGLASS O 4 STEEL CLAD W/FIBERGLASS REINFORCED PLAS'I'fC <br /> MATERIAL 6 CONCRETE 8 POLYVINYL CHLORIDE O 7 ALUMINUM 9 100% METHANOL COMPATIBLE W/FRP <br /> (Primary Tank) a p BRONZE 50 GALVANIZED STEEL = 96 UNKNOWN 09 OTHER <br /> RUBBER LINED 2 ALKYD LINING _L <br /> C.INTERIOR 1 <br /> 3 EPDXY LINING � a PHENOLIC LINING <br /> LINING 5 GLASS LINING UNLINED 95 UNKNOWN a 99 OTHER <br /> ----VIS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO^,,,. <br /> D,CORROSION 1 POLYETHYLENE WRAP O 2 COATING 3 VINYL WRAP4 FIBEAGLAS3 REINFORCEO PLASTIC <br /> PROTECTION a 5 CATHODIC PROTECTION II�� 91 NONE <br /> IJ Q 95 UNKNOWN a 99 OTHER <br /> E,SPILL AND OVERFILL SPILL CONTAINMENT INSTALLE=D(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) _ <br /> IV,PIPING INFORMATION CIACLE A IFABOVEGROUNDOR U IF UNDERGROUND,BOTH IFAPPLIOABLE <br /> A. SYSTEM TYPE A U t SUCTION A 2 PRESSURE A U 3 GRAVITY A U 99 OTHER <br /> B. CONSTRUCTION Ap 1 SINGLE WALL A U 2 DOUBLE WALL A U S LINED TRENCH A U 96 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)A U 4 FIBERGLASS PIPE <br /> CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEWiFRP <br /> PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN <br /> -"Y""' A U 99 OTHER_ <br /> D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING `-� 3 <br /> MONITORING 1:198 OTHF_R <br /> V,TANK LEAK DETECTION <br /> 11 VISUAL CHECK 2 INVENTORY RECONCILIATION 3 VADOZE MONITORING 4 AUTOMATIC TANK GAUGING a 5 GROUND WATER MON) <br /> �y!p TANK TESTING 7 INTURSTITIALMONITORING O 91 NONE 95 UNKNOWN 99 OTHER <br /> VI.TANK CLOSURE INFORMATION ::j <br /> EST:,. <br /> ATEO DATE T US q Mo/DAY/YR) 2.ESTIMATED QUANTITY OF 3,WAS TANK FILLED WITH r <br /> /(� t SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 YEs EJ NO . <br /> 7-HIS l ORM N S BEEN COMPLETED UNDER PENALTY O PE UR .AN TD THE BES-'OF MY <br /> APPLICANT`S NAME KNOWN EDGE, IS TRUE AND CORRECT <br /> ^^^��� <br /> IPPINYCD Q 813NATUR(,) / DATE <br /> LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS CO 0 ED OF THE FOUR NUMBERS BE OW <br /> STATE I.D,# <br /> COUNTY tr JURIS CTION to FACILITY A TANK A <br /> m � I <br /> 'EfaMiT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE <br /> FORM R (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED, <br /> ' FOR00.118.R5 <br />