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STATE OF CALLFOR WATER RESOURCES CON ARD ••':.�:.'��, <br /> FORM `B': ;�` UNDERGROUND STORAGE TANK PROGRAM o <br /> TANK <br /> LTANK PERMIT APPLICATION MfORMATION ` <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWIN FORMATION FOR EACH TANK. ro' <br /> MARK ONLY ❑1 NEW PERMIT ❑3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY i <br /> ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TAN OSURE 8 TANK REMO D <br /> re <br /> FACILITY/SITE NAME WHERE TANK IS INSTALLED: BP O i 1 CO p ey Fatility t E I 1 194 FARM TANK.Y o NO <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY � <br /> Ca <br /> FCa. OWNERS TAPHK IDM Unknown B. MANUFACTURED BY: Xerxes co <br /> .YEAR INSTALLED 1986 D. TANK CAPACITY IN GALLONS: 1 ,000 <br /> 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. <br /> A. 1 MOTOR VEHICLE FUEL F_�2 PETROLEUM B. C. [j 1 UNLEADED 2 LEADED 3 DIESEL <br /> 3 CHEMICAL PRODUCT ®4 OIL 1 PRODUCT 4 GASAHOL 5 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS E]80 EMPTY Ej 95 UNKNOWN ❑X 2 WASTE 7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF <br /> HAZARDOUS SUBSTANCE STORED&CA.S.M CA.S.M: <br /> I11. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,8,C,A D <br /> A.TYPE OF ® 1 DOUBLE WALLED 3 SINGLE WALLED WITH ERTBHIOR LINER 95 UNKNOWN <br /> SYSTEM 2 SINGLE WAL LM 4 SECONDARY CONTAINMENT 99 OTHER <br /> 1 STEEUIRON 2 STAINLESS STEEL ®3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> B.TANK F_�5 CONCRM 6 POLYVINYL CHLORIDE F�7 ALUMINUM 8 100%METHANOL COMPATIBLE FRP <br /> MATERIAL <br /> 9 BRONZE 10 GALVANIZED STEEL [:)95 UNKNOWN 99 OTHER <br /> C.INTERIOR KYD <br /> 1 RUBBER LINED 2 ALUNING �3 EPDXY LINING 4 PHENOLIC UNING <br /> LINING ❑5 GLASS LINING ®6 UNUNED 95 UNKNOWN <br /> E] IS LINING MATERIAL COMPATIBLE WITH Ioo%METHANOL? YES [D NO 99 OTHER <br /> D.CORROSION ❑ 1 POLMHIENEWRAP ❑2 TAR OR ASPHALT 0 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION []5 CATHODIC PROTECTION ®91 NONE 95 UNKNOWN 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 Q3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER <br /> B.CONSTRUCTION A U 1 SINGLE WALLED A DOUBLEWALLED 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(D 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 8100%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 P S 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS P�S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS <br /> P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1.ESTIMATED DATE LAST USED(MO/YR) 2.ESTIMATED QUANTITY OF3.WAS TANK FILLED WITH <br /> GALLONS <br /> SUBSTANCE REMAINING IN INERT MATERIAL? [:]YES ONO <br /> THIS FORM HAS BEEN COMPLETED UNDER ENALTY O P RJURY,AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED S SIGN DATE <br /> ' W. J. Hollis May 31 1989 <br /> LOCAL AGENCY USE ONLY <br /> COUNTY M JURISDICTION M AGENCY M FACILITY ID M TANK ID M <br /> 1-1 <br /> 10,10 o Ll 1 1 <br /> -1 <br /> [CURRENT LOCAL AGENCY FACILITY ID M APPROVED BY NAME PHONE a WITH AREA CODE <br /> r <br /> 7 ` <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> CHECK• PERMIT AMOUNT I SURCHARGE AMT. 11 FEE CODE RECEIPT N BY• <br /> FORM B(6-29-88) THIS FORM MUST BE ACCOMPANIrO BY A FACILITY/SITE APPLICATION, FORM `A',UNLESS/ CURRENT FORMA' HAS BEEN FILED(/" <br /> \ DATA PROCESSING COPY <br />