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STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. " MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE a TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: AiRpou S ffEu- I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN LL A OWNERS TANK I.D.R 7 O - B. MANUFACTURED BY: FEEL: C. DATE INSTALLED(MMAYNEAR) 1273 D. TANK CAPACITY IN GALLONS: 104 tgoo II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. A I IN 1 MOTOR VEHICLE FUEL ❑ d OIL B. C. 1a RCGUTAP UMFADm ❑ 3 DIESEL ❑ 8 AVIATION GAS F2 PETROLEUM ❑ BO EMPTY 1 PRODUCT tb P .= REMM WLEADm ❑ 0 GASAHOL ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ to MDGRADE UNLEADEDO 5 JET FUEL ❑ 8 M85 ❑ 2 LEADED ❑ 99 OTHER(DESCRIBE IN ITEM 0.BELOM D. IF(Al)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 ALL THAT APPLIES IN BOX D AND E A. TYPE OF y❑I-'�yy 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN E SYSTEM X 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ d STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE WIFRP "mMy TNI) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER LINED �❑ 2 ALKYO LINING ❑ 3 EPDXY LINING ❑ d PHENOLIC LINING LINING OR ❑ 5 GLASS LINING //�I 6 UNLINED ❑ 95 UNKNOWN E:] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO_ D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ d FIBERGLASS REINFORCED PLASTIC CORROSION I PROTECTION ❑ 5 CATHODIC PROTECTION M91 NONE F-1 95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL,BLC. SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) DROP TUBE YES_ NO_ STRIKER PLATE YES_ NO_ DISPENSER CONTAINMENT YES_ NO IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND,BOTH IFAPPLICABLE A. SYSTEM TYPE A U 1 SUCTION A V2 PRESSURE A U 3 GRAVITY A U d FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A g)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 v i BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U d FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑t v:nubw ux6 IFAX ❑2 MiE TDI M ❑3 mm9Nau3 NTEAm9u ❑d pE0 tc u9L (]5 Awro m wW OEIECT011 TES1Rq 4 Twm f21dt OETECmR SNUI9ONN ❑ 99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 MANUAL INVENTORY IATION ❑ 3 VADOMONITORING ❑ d AUTOMATIC TANK ❑5 GGRROUND GTER ❑6 TESTING❑ 7 MONITORING INTERSTITIAL ❑ 6 SIR ❑ 9 TANKER ANOA ❑10 MONTHLY TANK a 95 UNKNOWN ❑99 OTHER STIN VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST USED(MOIDAYNR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES ❑ NO SUBSTANCE REMAINING GALLONS INERT MATERIAL T THIS FORM HAS BEEN C PLETED DER PENAOF RJURY;AN TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT TANK OWNEWA S NAM / pg7E (AHK 656NATA y LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED 0 E FOUR Nu'WaS BELOW COUNTY L JURISDICTION R FACILITY A TANK L STATE I.D.# m PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORMA,UNLESS A CURRENT FORMA HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALIATONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. RLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (695)