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/ 11/ STATE OF CALIFORNIA e`.°6�...'�'. STATE WATER RESOURCES CONTROL BOARD 3 �� a L UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B y C-l„p�� c COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLO ONE ITEM ❑ 2 INTERIM PERMIT ❑ ONE 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE [—X]8 TANK REMOVED/U� / DBAOR FACILITY NAME WHERE TANK IS INSTALLED: DiSa1Vo Trucking Co. EADED ❑ 10PREMIUM ❑ 3 FIBERGLASS I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# ❑ 4 OIL B. MANUFACTURED BY: unknown C. DATE INSTALLED(MO/DAY/YEAR) unknown D. TANK CAPACITY IN GALLONS: 12,000 l ILTANKCONTENTS IFA -11S MARKED. COMPLETE ITEM C. A ® 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. REGULAR C. ❑ 1aUN SYSTEM 3 DIESEL ❑ 6 AVIATIONGAS ❑ 2 PETROLEUM ❑ 80 EMPTY ® 1 PRODUCT EADED ❑ 10PREMIUM ❑ 3 FIBERGLASS 4 GASAHOL ❑ 7 METHANOL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM UNLEADED (PrimaryTwk) J L ❑ 10 GALVANIZED STEEL ❑ 3 CHEMICALPRODUCT ❑ B5 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED ❑ 5 GLASS LINING ® 6 UNLINED C.A.S.#: ❑ 99 OTHER III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C, AND ALL THAT APPLIES IN BOX D AND A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN SYSTEM ® 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK ® 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (PrimaryTwk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER 4 FIBERGLASS PIPE 8 100% METHANOL COMPATIBLE W/FRP 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR LINING ❑ 5 GLASS LINING ® 6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO_ D.CORROSION ❑ 1 POLYETHYLENE WRAP ® 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHDDICPROTECTK)N ❑ 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 ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION AU02 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER. C. MATERIAL AND CORROSION PROTECTION A(p A U A U 1 BARE STEEL 5 ALUMINUM 9 GALVANIZED STEEL A U A U A U 2 STAINLESS STEEL A U 6 CONCRETE A U 10 CATHODIC PROTECTION 3 POLYVINYL CHLORIDE (PVC) A U 7 STEEL W/ COATING A U A U 95 UNKNOWN A U 4 FIBERGLASS PIPE 8 100% METHANOL COMPATIBLE W/FRP 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR Eil 2 LINE TIGHTNESS TESTING ❑ 3 MONRORING ❑ 99 OTHER V. TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 311192 /1/92 SUBSTANCE REMAINING THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJ ) APPLICANTS NAME (PRINTED & SIGNATURE) John S. Tunoor„ #ase 3. WAS TANK FILLED WITH YES [:]NO 100 GALLONS INERTMATERIAL? [X] AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT 1 3/5/92 LOCAL AGENCY USE ONLY THE STATE I.D. NUMBEO CAMPOSED OF THE FOUR NUMBERS BiLOW COUNTY RISDICTION # FACILITY # TANK # (5A STATE LD.# 3 = b ?5 b b o I PERMITNUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE �>- 121- IJ FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED