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eaou STATE OF CALIFORNIA ooiA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B :� r At COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. 7524-35 MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5CHANGE OF INFORMATION F-17 PERMANENTLY CLOS E ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT In 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS-- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.a 7524-35-RU-2 B. MANUFACTURED BY: RHEEM C. DATE INSTALLED(MO/DAY/YEAR) 1967 D. T"NK CAPACITY IN GALLONS: 5 , 000 II.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. A 1 MOTOR VEHICLE FUEL 4 OIL g, C is REGULARn 3 DIESEL 6 AVIATION GAS UNLEADED u�i 2 PETROLEUM El So EMPTY 1 PRODUCT lb PREM IUM 4 F-] 5 GASAHGASAHJET FUEL ❑ 7 METHANOL UNLE❑ 3 CHEMICAL PRODUCT O 95 UNKNOWN a 2 WASTE a 2 LEADED a 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.>r III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALLTHAT APPLIES IN BOX D AND E A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER Ej 95 UNKNOWN SYSTEM 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK 1 BARE STEEL F-] 2 STAINLESS STEEL [-] 3 FIBERGLASS F-] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE F-] 6 POLYVINYL CHLORIDE E] 7 ALUMINUM O 8 100°/ METHANOL COMPATIBLE W/FRP (Primary Tank) F-1 9 BRONZE [-] 10 GALVANIZED STEEL 95 UNKNOWN Q 99 OTHER F-1 1 RUBBER LINED ❑ 2 ALKYD LINING 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING ❑ 6 UNLINED 95 UNKNOWN 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO— D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING F-] 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE Rl 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 A,& 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A Lo 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)4nFIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER EllTI D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING ❑ MONITORING ❑99 OTHER V.TANK LEAK DETECTION Fv'�-- 1 VISUAL CHECK�NVENTORY RECONCILIATION ❑ 3 VADOZE MONITORIN 5 GROUND WATER MONITORING 6 TANK TESTING w�❑ 7 INTERSTITIAL MONITORING Q 91 NONE 95 UNKNOWN O 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 YES O NO THIS FORM HAS BEEN COMPL,fr7D UNDE ALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS RU AND CORRECT APPLICANTS NAMEN p/J/� - p7E I 2f(PRINTED arSNA M -A �A LOCAL AGENCY USE ONLY T E STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.# �, p PERMIT NUMBER 'f PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE rte;: FORMS (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FI FOR0030-: 0 l�