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STATE OF CALIFORNIA <br />STATE WATER RESOURCES CONTROL BOARD <br />W up <br />UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B <br />n -'•e' .i� to <br />COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br />MARK ONLY a 1 NEW PERMIT [:] <br />3 RENEWAL PERMIT <br />I -X] 5 CHANGE OF INFORMATION <br />0 7 PERMANENTLY CLOSED ONSITE <br />ONE ITEM 2 INTERIM PERMIT Cl <br />4 AMENDED PERMIT <br />0 6 TEMPORARY TANK CLOSURE <br />0 8 TANK REMOVED <br />DBA OR FACILITY NAME WHERE TANK IS INSTALLED: <br />ARCO Facility <br />548 <br />O 2 STAINLESS STEEL <br />I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF IJNKNnWN <br />A. OWNER'S TANK I. D. # Unknown <br />B. MANUFACTURED BY: Xerxes <br />C. DATE INSTALLED (MO/DAY/YEAR) 7/95 <br />_ <br />D. TANK CAPACITY IN GALLONS: 1 O OOO <br />II. TANK CONTENTS IFA.I1CUApKCnrnAADICTCITCEAr <br />A. 1 MOTOR VEHICLE FUEL 4 OIL <br />B. <br />C X❑ REGULAR3 DIESEL 6 AVIATIONGAS <br />0 2 PETROLEUM 80 EMPTY <br />® 1 PRODUCT <br />UNLEADED <br />O lb PREMIUM <br />GET O 7 METHANOL <br />0 3 CHEMICAL PRODUCT 95 UNKNOWN <br />a 2 WASTE <br />UNLEADED 5 FUEOL <br />0 2 LEADED 99 OTHER (DESCRIBE IN ITEM D. BELOW) <br />D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S. #: <br />III. TANK CONSTRl1CTION UAnW nNC ITC1A nMll v Ini Onvcc A D AAIn n - <br />A. TYPE OF <br />IV. <br />® 1 DOUBLE WALL <br />El 3 SINGLE WALL WITH EXTERIOR LINER <br />0 95 UNKNOWN <br />SYSTEM <br />F-1 2 SINGLE WALL <br />O 4 SECONDARY CONTAINMENT <br />(VAULTED TANK) <br />F-] 99 OTHER <br />B. TANK <br />1 BARE STEEL <br />O 2 STAINLESS STEEL <br />3 FIBERGLASS <br />E:] 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC <br />MATERIAL <br />5 CONCRETE <br />u 6 POLYVINYL CHLORIDE <br />7 ALUMINUM <br />8 100°/ METHANOL COMPATIBLE W/FRP <br />(Primary Tank) <br />9 BRONZE <br />10 GALVANIZED STEEL <br />O 95 UNKNOWN <br />99 OTHER <br />1 RUBBER LINED <br />2 ALKYD LINING <br />F-]3 EPDXY LINING <br />� 4 PHENOLIC LINING <br />C. IN <br />LINING <br />❑ 5 GLASS LINING <br />L, 6 UNLINED <br />❑ 95 UNKNOWN <br />E:l 99 OTHER <br />IS MATERIAL COMPATIBLE WITH 100% METHANOL? <br />YES _ NO <br />D. CORROSION <br />1LINING <br />1 POLYETHYLENE WRAP <br />0 2 COATING <br />F-1 3 VINYL WRAP <br />4 FIBERGLASS REINFORCED PLASTIC <br />PROTECTION <br />O 5 CATHODIC PROTECTION <br />® 91 NONE <br />Ej 95 UNKNOWN <br />0 99 OTHER <br />E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) 95 <br />OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR)--9-5- <br />YEAR)95 <br />IV. PIPING INFORMATION CIRCLE A [FAROVFGRni]Nnnp 11 IFLiNnCprpnijmn OnTUICADDt IrADI C <br />A. SYSTEM TYPE <br />A U <br />1 SUCTION <br />AID 2 PRESSURE A U <br />3 GRAVITY A U 99 OTHER <br />B. CONSTRUCTION <br />A U <br />1 SINGLE WALL <br />A® 2 DOUBLE WALL A U <br />3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br />C. MATERIAL AND <br />CORROSION <br />PROTECTION <br />A U <br />A U <br />A U <br />1 BARE STEEL <br />5 ALUMINUM <br />9 GALVANIZED STEEL <br />A U 2 STAINLESS STEEL A U <br />A U 6 CONCRETE A U <br />A U 10 CATHODIC PROTECTION <br />3 POLYVINYL CHLORIDE (PVC) A 0 4 FIBERGLASS PIPE <br />7 STEEL W/COATING A U 6 100% METHANOL COMPATIBLE W/FRP <br />A U 95 UNKNOWN A U 99 OTHER <br />D. LEAK DETECTION <br />® 1 <br />AUTOMATIC LINE LEAK DETECTOR [-] 2LINE TIGHTNESS TESTING 3 E IA <br />MONITORING ❑ 99 OTHER <br />V. TANK LEAK DETECTION <br />1 VISUAL CHECK 2 INVENTORY RECONCILIATION 0 3 VADOZE MONITORING 4 AUTOMATIC TANK GAUGING a 5 GROUND WATER MONITORING <br />1700 <br />6 TANK TESTING ® 7 INTERSTITIAL MONITORING CI 91 NONE 95 UNKNOWN F-] 99 OTHER <br />VI, TANK CLOSURE INFORMATION <br />1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES NO 0 <br />SUBSTANCE REMAINING GALLONS INERT MATERIAL ? <br />THIS FORM HAS BEEN 00PLETED UNDER N 7Y OF PERJU AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br />APPLICANTS NAM DATE <br />(PRINTED&SIG RE) Thomas Schoenstein 5/23/95 <br />LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW <br />COUNTY # JURISDICTION # <br />FACILITY # TANK # <br />STATE I.D.# <br />- `--- <br />-- <br />ERMIT NUMBER <br />PERMIT APPROVED BY/DATE <br />PERMIT EXPIRATION DATE <br />THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. <br />FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS <br />FORM B (12-91) <br />FOR00348-R6 <br />