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" SOURCES, <br /> if <br /> STATE(WCALIFORMA r <br /> STATE WATER RESOURCES CONTROL BOARD 3 , <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B <br /> Cil It OR N�. <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br /> MARK ONLY F 1 NEW PERMIT O 3 RENEWAL PERMIT ;5 CHANGE OF INFORMATION E::] 7 PERMANENTLY CLOSED ON SITE <br /> ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT B TEMPORARY TANK CLOSURE 8 TANK REMOVED <br /> DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Bldg , 647 SbArpe Depot <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS•- SPECIFY IF UNKNOWN <br /> A. OWNER'S TANK I.D.# B. MANUFACTURED BY: Unknown <br /> C. DATE INSTALLED(MO/DAYNEAR) n IG Y1tn D. TANK CAPACITY IN GALLONS: 55 <br /> If.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. <br /> ® 1 MOTOR VEHICLE FUEL a 4 OIL B. C. 1a REGUL R ® 3 DIESEL ` <br /> A. 6 AVIATION GAS <br /> j 2 PETROLEUM 80 EMPTY 1 PRODUCT 1bUNLEAIDED 5 GET FUEL <br /> 0 7 METHANOL A <br /> 3 CHEMICAL PRODUCT 95 UNKNOWN F2 WASTE 2 LEADED 99 OTHER(DESCRIBEIN ITEM D. BELOW) <br /> D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED <br /> C.A.S.# <br /> III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALL THAT APPLIES IN BOX D AND E <br /> A. TYPE OF 0 1 DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER a 95 UNKNOWN <br /> SYSTEM E 2 SINGLE WALL 4 SECONDARY CONTAINMENT (VAULTEDTANK) F 99 OTHER <br /> »� E 1 BARE STEEL F__] 2 STAINLESS STEEL 3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B. TANK <br /> MATERIAL ❑ 5 CONCRETE 6 POLYVINYL CHLORIDE 7 ALUMINUM 8 100% METHANOL COMPATIBLE W/FRP <br /> (Primary Tank) 9 13RONZE10 GALVANIZED STEEL E::] 95 UNKNOWN 99 OTHER <br /> 1 RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING a 4 PHENOLIC LINING <br /> C.INTERIOR D 5 GLASS LINING ® 6 UNLINED a 95 UNKNOWN 99 OTHER <br /> LINING <br /> IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO <br /> 2 COATING 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC <br /> D.CORROSION F 1 POLYETHYLENE WRAP a <br /> PROTECTION 5 CATHODIC PROTECTION 91 NONE 95 UNKNOWN 99 OTHER `a <br /> E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) None OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR)--_... <br />' OCIf? <br /> ,z <br /> IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A. SYSTEM TYPE U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER <br /> 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 <br /> C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE <br /> CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 SLW/COATING <br /> A U 8 100% METHANOL COMPATIBLE W/FRP <br /> PROTECTION A U 9 GALVANIZED STEEL A U" 10 CATHODIC PROTECTION U 95 UNKNOWN p U gg OTHER <br /> D. LEAK DETECTION 0 1 AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING 3 M RS I IAL <br /> MONfiORING �'99 OTHER__b[QrLa <br /> V.TANK LEAK DETECTION <br /> 1 VISUAL CHECK 2 INVENTORY RECONCILIATION O 3 VADOZE MONITORING 4 AUTOMATIC TANK GAUGING 5 GROUND WATER MONITORING <br /> 6 TANK TESTING 7 INTERSTITIAL MONITORING E:] 91 NONE 95 UNKNOWN 99 OTHER <br /> w <br /> VI.TANK CLOSURE INFORMATION <br /> Fl.7ES;715M7ATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES NO <br /> Unknown SUBSTANCE REMAINING GALLONS INERT MATERIAL? FX <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OFfE0UW,ANDT0 THE BEST OF MY,$fOWLEDGE, IS TRUE AND CORRECT <br /> APPLICANT'S NAME <br /> 00 <br /> (PRINTED 8 SIGNATURE) DATE l 3 <br /> Keith A. Tallis A e 19 gg <br /> LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW <br /> COUNTY# JURISDICTION# FACILITY# TANK# <br /> STATE LD.# F3 I 13141L 19 3 g - <br /> PERMIT NUMBERPERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE ; <br /> FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. <br /> 9 � FOR0034B-R5r <br /> ,,ms`s war..zaz.�,ax>, nd•� .. <br />