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STATE OF CALIFORNIt WATER RESOURCES CONTR OARD FORM `B': LINDE GROUND STORAGE TANK PROGRAM TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. ,m MARK ONLY ❑ 1 NEW PERMIT ❑3 RENEWALPERMIT CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED TAN' ONE ITEM ❑2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED IS FACILITY/SITE NAME WHERE TANK IS INSTALLED: FARM TANK-YES❑ NO I. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKN N—SO SPECIFY 10 V A. OWNERS TANK ID# # B. MANUFACTURED BY: C. YEAR INSTAL D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. CAI CO A. ❑ 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM B. C. ❑ 1 UNLEADED ❑2 LEADED ESEL . ❑3 CHEMICAL PRODUCT ❑ 4 OIL 1 PRODUCT ❑4 GASAHOL ❑5 JET FUEL ❑6 AVIATION GAS ❑5 HAZARDOUS ❑ 80 EMPTY ❑ 95 UNKNOWN ❑2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM O BELOW) PrIIIF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAYARQOUS SUBSTANCE STORED&C.A.S.# 1L r C.A.S.II: KIII. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,8,C,&D A.TYPE OF ❑ I DOUBLEWALLED ❑3 SINGLE WALLED WITH D(TERIOR LINER 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ❑99 OTHER B.TANK i. ❑' I STEEUIRON ❑2 STAINLESS STEEL E]3 R ,S [DBERGLAS4 STEEL CLAD W/RBERGLASS REINFORCED PLASTIC5 CONCRETE MATERIAL ❑6 POLYVINYLCHLORIDE ❑7 A M ❑B 100%METHANOL COMPATIBLE FHP ❑9 BRONZE ❑10 GALVANIZED STEEL UNKNOWN ❑99 OTHER C.INTERIOR ❑ 1 RUSBERUNED ❑2 ALKYD LINING ❑3 EPDXY UNING ❑4 PHE LIC LINING LINING ❑5 GLASS LINING ❑6 UNUNED UNKNOWN ❑IS LINING MATERIALCOMPA71BLE WITH 100%METHANOL? ❑YES ❑ NO ❑99 OTHER D. CORROSION ❑ 1 POLYETHLENE WRAP ❑2 TARORASPHALT ❑3 PVKWRAP ❑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 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH U 5 UNKNOWN A U 99 OTHER A U i STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASSPIPE C. MATERIAL A U 5 ALUMINUM A 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 9 GALVANIZED STEEL .. N5 UNKNOWN A U 99 OTHER A U 8100%METHANOL COMPATIBLE FHP V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P VISUAL CHECK 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS PRECI P8 SION TESTING P 8 7 PRESSURETESTING P S 91 NONE P 8 95 UNKNOWN P 8 99 OTHER Flivi. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3, WAS TANK FILLED WITH 1� SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? ❑YES [:] NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PRJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. 7777!7��- LOCAL AGCY USE ONLY COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# 00 CURRENT LOCAL AGENCY FACILITY 10 x APPROVED BY NAME IO/ PHONE WITH AREA CODE /L PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION rTE CHECK# PERMIT AMOUNT SURCHARGE AMT. FEE CbDE ECEIPTM BY: `u FORM B(3-7-88) THIS FORM MUST BE ACCOMPANIPOM A FACILITY/SITE APPLICATION, FORM 'A',UNLESS A RENT FORM'A' HAS BEEN FILED DATA PROCESSING COPY