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%We SKIMMER TANK STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD 8 UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I 1 NEW PERMIT ❑ 3 RENEWAL PERMIT � 5 LHANG'c OF INFORMATION L'., 7 PERMANENTLY CLOSED OfI SIT'c MARK ONLY 1 2 INTERIM PERMIT ❑ A AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED I ONE REM I._I DBA OR fACILTTY NAME WHERE TANK IS INSTALLED: � � � I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN BMNUFACTUREDBY: A OWNER'S TANK I.O.a UL#'J-396660 STI-P3 Ki hland Tank & Mfg. Co. D. TANK CAPACITY IN GALLONS: 500 C. DATE INSTALLED(MO YNEAR) ],1/11/87 ILTANKCONTENTS IFA-1 ISMARKED.COMPLETEITEMC. 1a REGULAR 3 DIESEL 6 AVIATION GAS A ( 1 MOTOR VEHICLE FUEL ❑ A OIL 0. C. ❑ UNLEADED A GASNOL 7-1 2 PETROLEUM ® 00 EMPTY I ❑ 1 PRODUCT ❑ tDUNLEADED 5 JET FUEL ❑PREMIUM 7 METHANOL 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN I 2 WASTE ( ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM O. BELOW 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED Waste 0115 C.A.S.S: N A III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.S.AND C.AND ALL THAT APPLIES IN SCX0 r7Mry PE OF IR •' t DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINEA J 95 UNKNOWN YSTEM 2 SINGLE WALL ❑ a SECONDARY CONTAINMENT (VAULTED TANK) 99 OTHER IX 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 7 FB^cRGV35 j ISI s ST'c'cL C'.AD WI FIBERG'.ASS REiNFORL'cD PLASTIC TANK ❑ 8POLYVINYL CHLORIDE ❑ 7 AUMINUMj lI 6 100. MET}iANCL COMPATISLW/FRP ATERIAL ! 5 CONCRETEmuyT=k) �i 9 BRONZE ❑ 10 GALVNIZED STEEL I 95 UNKNOWN ❑ 99 OTHER 77, 1 RUBBER LINED ❑ 2 AKYO LINING ❑ 3 EPDXY LINING A PHENOLIC LINING C.INTERIOR —1 5 GLASS LINING ❑ 6 UNLINED 95 UNKNOWN W OTHER UNWG IS LINING MATERIAL COMPATIBLE WITH 100%MEiHANOL? YES_ NO_ I 1 POLYETHYLENE WRAP F7 2 COATING = 3 VINYL WRAP A FIBERGLASS RENFORCED PLASTIC D.CORROSION - ❑ 95 UNKNOWN ❑I 99 OTHER PROTECTION Z] PROTECTION5 CATHODIC PROTECTION ❑ 91 NONE IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.30TH IF APPLICABLE EMATERIAL E A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U W OTHER TION A U 1 SINGLE WALL A 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, AND A U 1 BARB STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE;PVC}A U s PB-cRGLASS PIPE N A U 5 AUMINUM A U 6 CONCRETE A© 7 STE LWI COATING A U 6 ICC% METHANOL COMPATIBLEWIFRP N A U 9 GALVANIZED STEEL AO 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER ECTION 1 AUTOMATIC LINE LEAK DETeCT^R 2 LINE TIGHTNEESS 7237ING ' 'NONRCRING 99 OTHER V.TANK LEAK DETECTION 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION j'1 3 VAPOR MONITORING J1 A AUTOMATIC TANK GAUGING J 5 GRCUND WATEA MONITORING I 6 TANK TESTING ( X 7 INTERSTITIAL MONITORING F-I 91 NONE ❑ 95 UNKNOWN 99 OTHER VI.TANK CLOSURE INFORMATION ESTIMATED QUANTITY OFTANK FILLED WI 1.ESTIMATED DATE'LAST USED IMDIOAYRR) 2 SUBSTANCE REMAINING GALLONS 3WA INERTMATEMAL?H YES L NO 1 THIS FORM HAS BEEN COMPLETED UNDER PENALPE JURY AND TO THE B T OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME T OATE IPWNTEDASIGNATURO chard A L"Recor 1/ OCt 2 1992 LJP LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY it JURISDICTION# FACILITY# TANK# STATE 04Z 5 i012 f/ PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE FORM B (990) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN F