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STATE OF CALIFORNI,. WATER RCESOURCES CONTRC-OARD <br /> FORM `B': UNDERGROUND STORAGE TANK PROGRAM <br /> -���� TANK PERMIT APPLICATION INFORMATION ,o <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. ^� z <br /> MARK ONLY ❑ 1 NEW PERMIT 3 RENEWAL PERMIT ®5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED TANK <br /> ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE E]8 TANK REMOVED <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: BP OIL COMPANY FACILITY SITE #11192 FARM TANK-YES❑ <br /> ' 4 <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY CD <br /> A. OWNERS TANK IDN UNKNOWN B. MANUFACTURED BY: UNKNOWN <br /> (� <br /> C. YEAR INSTALLED 1974 D. TANK CAPACITY IN GALLONS: 3 OOO <br /> II. TANK CONTENTS IF(a1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. ❑ 1 MOTOR VEHICLE FUEL 2 PETROLEUM B. C [::] 1 UNLEADED Ej 2 LEADED 3 DIESEL <br /> 3 CHEMICAL PRODUCT ®4 OIL ® i PRODUCT E]4 GASAHOL 5 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS 80 EMPTY 0 95 UNKNOWN 2 WASTE 1:1 7 METHANOL ® 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.N C.A.S.N: <br /> I11. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C.&D <br /> A.TYPE OF ❑ I DOUBLE WALLED F--j 3 SINGLE WALLED WITH EXTERIOR LINER F-�95 UNKNOWN <br /> SYSTEM ®2 SINGLE WALLED 4 SECONDARY CONTAINMENT 99 OTHER <br /> ® 1 STEELARON 2 STAINLESS STEEL ❑3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B.TANK <br /> MATERIAL �5 CONCRETE r--j 6 POLYVINYL CHLORIDE F-17 ALUMINUM r-18 100%METHANOL COMPATIBLE FRP <br /> ❑9 BRONZE 10 GALVANIZED STEEL 95 UNKNOWN E]99 OTHER <br /> 1 RUBBER LINED 2 ALKYD UNING 3 EPDXY LINING 4 PHENOUC UNING <br /> C.LINING INTERIOR ❑5 GLASS LINING FX 6 UNLINED F-�95 UNKNOWN <br /> E]IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? E]YES ❑NO [:]99 OTHER <br /> D.CORROSION ❑ I POLYETHLENE WRAP 2 TAR OR ASPHALT ❑3 VINYL WRAP F-1 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION ❑5 CATHODIC PROTECTION 91 NONE [:]95 UNKNOWN E]99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE <br /> 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 <br /> B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 FIBERGLASS PIPE A U 91 NONE <br /> C.MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. <br /> P S 1 VISUAL CHECK 0 8 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P 8 4 ELECTRONIC MONITOR P 8 5 GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P 8 91 NONE P 8 95 UNKNOWN 8 99 OTHER 1`1b-1 <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 6GAr3o' <br /> 1. ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH <br /> SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? 0 YES Ej NO <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICAN ' AME(PRINT N E) DATE <br /> -� o W.J. H0117-1-May 31, L989 <br /> LOCAL AGENCY USE 014CY <br /> COUNTY# JURISDICTION N AGENCY M FACILITY ID N TANK ID N <br /> = L I 1-1 El I I I � I N I lig� <br /> CURRENT LOCAL AGENCY FACILITY ID# APPROVED BY NAME PHONE r WITH AREA CODE <br /> L b <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> CHECK U PERMIT AMOUNT SURCHARGE AMT. FEE CODE "4CEIPT 11 BY: <br /> FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIED BY A FACILITY/SITE APPLICATION, FORM 'A',UNLESS RRENT FORMA' HAS BEEN FILED <br /> DATA PROCESSING COPY <br />