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STATE OF CALIFORNI0 WATER RESOURCES CONTROOARD FORM `B': UNDERGROUND STORAGE TANKFORMATION TANK A SEPARATE FORM WITH TANK PERMIT APPLICATION COMPLETE THE FOLLOWIN FORMATION FOR EACH TANK. " 1 NEW PERMIT F-13 RENEWAL PERMIT 5 CHANGE OF INFORMATION �7 PERMANENTLY CLOSED TANK MARK ONLY F-1 Q CA) ONE ITEM ❑2 INTERIM PERMIT ❑4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED RM TANK-YES❑ NO W FACILITY/SITE NAME WHERE TANK IS INSTALLED: Z .%s-37 � I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY CD B. MANUFACTURED BY: A. OWNERS TANK 10# D. TANK CAPACITY IN GALLONS: Q G YEAR INSTALLED II. TANK ONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A. 1 MOTOR VEHICLE FUEL F-12 PETROLEUM B C. ❑ 1 UNLEADED ❑ 2 LEADED DIESEL ❑ 1 PRODUCT ❑ 4 GAGAHOL E] 5 JET FUEL ❑6 AVIATION GAS 3 CHEMICAL PRODUCT F-1 4 OIL ❑5 HAZARDOUS ❑ 80 EMPTY ❑95 UNKNOWN 2 WASTE ❑7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM O,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.#: HAZARDOUS SUBSTANCE STORED&C.A.S.# III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D UBLE WALLED ❑3 SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN FTANKF-1 ❑99 OTHER NGLEWALLED ❑4 SECONDARY CONTAINMENT TEELIIRON ❑2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC ONCRETE ❑6 POLYVINYLCHLORIDE 7 ALUMINUMEl B 100%METHANOL COMPATIBLE FRP RONZE ❑10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBERUNED ❑2 ALKYD LINING ❑3 EPDXY LINING ENOUC LINING C. INTERIOR 95 OATH ER KNOWN LINING ❑ 5 GLASS LINING ❑6 UNLINED ❑ IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL9 YES [j NO 99 D. CORROSION ❑ 1 POLYETHLENE WPAP ❑2 TAR OR ASPHALT ❑ 3 VINYL ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑5 CATHODIC PROTECTION ❑91 NONE NKNOWN ❑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 U 5 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE C.MATERIAL A U 5 ALUMINUM A A CONCRETE A U 7 STEEL CLAD W/FRP A U 8100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A UNKNOWN A U 99 OTHER V LEAK DETECTION SY EM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. 8 1VISUAL CHECK P11 8 INVENTORY RECONCILIATION P 8 3VADOSEWELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUNDWATER MONITORING WELLS V P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P 8 91 NONE P 8 95 UNKNOWN P S 99 OTHER {/ VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 3.WAS TANK FILLED WITH 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF INERT MATERIAL? []YES [:] NO SUBSTANCE REMAINING IN GALLONS THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOW TE DGE,IS TRUE AND CORRECT, APPLICANT'S NAME(PRINTED 8 SIGNATURE) LOCAL AGENCY USE ONLY FACILITY IIID# TANK 10# COUNTY# JURISDICTION � AGE CURRENT LOCAL AGENCY FACILITY ID# � .Y APPROVED BY NAME PHONE#WITH AREA CODE PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE C CMECKM PERMIT AMOUNT SURCHARGE AMT. FEE CODE ECEIPT a IEY:(� FORM 6(8-29-88) THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE AROC APPLICATION, FORM 'A',UNLESS A CURRENT FORM'A' HAS BEEN FILED