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STATE OF CALIFORNWATER RESOURCES CONTRaOMOARD -FORM 'B': UNDIAOUND STORAGE TANK PRWAM _ o TANK TANK PERMIT I INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. I MARK ONLY ❑1 NEW PERMIT ®3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED TANK ONE ITEM 2 INTERIM PERMIT ®4 AMENDED PERMIT ®6 TEMPORARY TANK CLOSURE J8 TANK REMOVED FACILITY/SITE NAME WHERE TANK IS INSTALLED:,. cAt FARM TANK-YES NO 00 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—ilo SPECIFY A. OWNERS TANK ID# S~ B. MANUFACTURED BY' C. YEAR INSTALLED D.`TANK CAPACITY IN GALLONS: 11. TANK 2ONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A. Da'l MOTOR VEHICLE FUEL ❑2 PETROLEUM B. C. ❑ 1 UNLEADED 2 LEADED 0 3 DIESEL ®3 CHEMICAL PRODUCT ®4 OIL1 PRODUCT ❑4 GASAHOL F_� 5 JET FUEL �6 AVIATION GAS 5 HAZARDOUS E]80 EMPTY �95 UNKNOWN E]2 WASTE El 7 METHANOL E j 99 OTHER(DESCRIBE IN ITEM D,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED&C.A.S.# C.A.S.#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN Box A,B,C,&D A.TYPE OF ❑1 DOUBLE WALLED 3 SINGLE WALLED WITH EXTERIOR LINER ❑95 UNKNOWN SYSTEM 2 SINGLE WALLED ❑4 SECONDARY CONTAINMENT ®99 OTHER Ej�rl STEEL/IRON ❑2 STAINLESS STEEL ❑3 FIBERGLASS ❑4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC B.TANK ®5 CONCRETE 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ®8 100%METHANOL COMPATIBLE FRP MATERIAL ®9 BRONZE ❑10 GALVANIZED STEEL [::]95 UNKNOWN ®99 OTHER ® 1 RUBBER LINED ®2 ALKYD LINING ❑ 3 EPDXY LINING ®4 PHENOLIC LINING C.LINING INTERIOR ®5 GLASS LINING LV6 UNLINED ®95 UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? ❑YES ❑ NO ®99 OTHER D.CORROSION ❑ 1 POLYETHLENE WRAP F_�YfAR OR ASPHALT ® 3 VINYL WRAP ®4 FIBERGLASS REINFORCED PLASTIC PROTECTION ®5 CATHODIC PROTECTION ff9l NONE ❑ 95 UNKNOWN ®99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A.SYSTEM TYPE A 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B.CONSTRUCTION A U SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 OTHER 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 C.MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 8 100%METHANOL COMPATIBLE FRP A PGALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR S FOR SECONDARY,A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P S 1 VISUAL CHECK P S 2 INVENTORY RECONCILIATION 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER VL INFORMATION TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE IST USED(MO/YR) 2. ESTIMATED QUANTI OF GALLONS 3.WAS T NK FILLSUBSTANCE RrED WITH SUBSTANCE R i I G IN INERT TERIAL? ❑YES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. APPLICANT'S NAME(PRINTED&SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANK ID# J -d s� El [�]L I o I S IPERMIT E T LOCAL AGENCY FACILITY ID# APP OV D B E PHONE#WITH AREA CODE LF NUMBER PERMIT APPROVAL DATE 'PERMIT PI TION DATE K# PERMIT AMOUNT SUR4HARGE AMT. FEE CODE RECEIPT FORM B(6-29-88) THIS FORM MUST BE ACCOMPANI , A FACILITY/SITE APPLICATION, FO `A',UNLESS INRENT FORMA' HAS BEEN FILED IDATA PROCESSINGY