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STATE OF CALIFORNIA WATER RESOURCES CONTROL -OARD <br /> FORM 'B': UNDERGROUND STORAGE TANK PRO(MAM <br /> TANK TANK PERMIT APPLICATION INFORMATION TANK. <br /> COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH <br /> MARK ONLY F� 1 NEWPERMIT 3 RENEWALPERMIT 5 CHANGE OF INFORMATION [:] 7 �ENI TANK <br /> ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE [rx-TANK RE oj I <br /> STALLED: -7, & FARNITANK-1 D NO <br /> FACILITY/SITE NAME WHERE TANK IS IN /,��-Z 5� gij� <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY <br /> A, OWNERS TANK ID N B. MANUFACTURED BI <br /> C, YEAR INSTALLED U TANK CAPACITY IN GALLONS: <br /> it=zi7 <br /> 11. ANK l;45NTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,96MPLETE ITEM D. <br /> A. I MOTOR VEHICLE FUEL 2 PETROLEUM B r. 1 UNLEADED Lj 2 LEADED 3 DIESEL <br /> 3 CHEMIrALPFODUCT 4 OIL �IPRODUCT 4 GASAHOL 5 JET FUEL 6 AVIATION GAS <br /> 5 HAZARDOUS 80 EMPTY [:] 95 UNKNOWN 2 WASTE 7 METHANOL 99 OTHER(DESCRIBE IN ITEM D,BELOW) <br /> D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF C.A.S.W <br /> HAZARDOUS SUBSTANCE STORED&C.A.S.If <br /> Jill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C,&D <br /> A.TPE OF MKWOLE WALLED F-]3 SINGLE WALLED WITH EXTERIOR LINER 96 UNKNOWN <br /> SYSTO [Y2 SINGLE WALLED F-�4 SECONDARY CONTAINMENT 99 OTHER <br /> Epri STEELARON 2 STAINLESS STEEL [:]3 FIBERGLASS 4 STEEL;LAD W/RBERGLASS REINFORCED PLASric <br /> B. TANX F-1 5 CONCIIETE 6 POLYVINYLCHLORIOE E]7 ALUMINUM 8 100%METHANOL OOMPATIBLEARP <br /> MATERIAL 0 9 BRONZE 10 GkVANIZED STEEL 95 UNKNOWN 99 OTHER <br /> F-1 I RUBBER LINED 2 ALKYD LINING 3 EPDXY LINING HENOLIC UNING <br /> C. INTERIOR ONKNOWN <br /> LINING 5 GLASS UN114G 6 UNLINED V2,v <br /> ISUNMMATERIALCOMPATIMVATHI00%METYMOL? YES NO Eyr99 OTHER <br /> 0. CORROSION 1 POLYETHLENE WRAP L]2 TAR 08 ASPHALT El 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION 5 CATHODIC PROTEMON [-]91 NONE V96 UN= [:]99 OTHER <br /> IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A. SYSTEM TYPE A a 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER <br /> A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINEDTRENCH A?*U795 UNKNOWN A U 99 OTHER <br /> A U I STEEL/IRON A U 2 STAINLESSSTEEL A U 3 POLYVINYLCHLORIDE(PVC) A U 4 FIBERGLASSPIPE <br /> C. MATERIAL A U 5 ALUMINUM 6 CONCRETE jA U 7 STEELCLADWIFRP A U B 100%METHANOL COMPATIBLE FRP <br /> A U 9 GALVANIZEDSTEEL 5 UNKNOWN -"A U 99 OTHER <br /> V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY,OR IS FOR SECONDARY,A PRIMARY LEAK 13ETECTION SYSTEM MUST BE CIRCLED. <br /> VISUAL CHECK P 8 2 INVENTORY RECONCILIATION P : 3 VADO 4 ELECTRONIC MONITOR P <br /> P 9 NON:EWELLS� : P : I GROUND WATER MONITORING WELLS <br /> PRECISION TESTING P 8 7 PRESSURETESTING 25-UNKNOWN 99 OTHER <br /> VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE <br /> 1.ESTIMATED DATE LAST USED(MO/YR) 2. ESTIMATED QUANTITY OF 3.WAS TANK BLLED WITH <br /> SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? [:]YES [-] NO <br /> THISFORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUEAND CORRECT <br /> NTS NAME(PRINTED&SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION# AGENCY# FACILITY ID# TANKIDf All <br /> CURRENT LOCAL AGENCY FACILITY 10 N APPROVED BY NAME PHONE WITH AREA CODE <br /> I'D <br /> IT <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> MT 1 11 <br /> CHECK* PERMIT AMOUNT ICIA111;A IT. FEE CODE IWECEIPT <br /> �/FORMEI(3-7�-88) THIS FORM MUST BE ACCOMPANIiEU BY:FACILITY/SITEAPPLicATiON, FORM W,uKm FORMIN HASBEENFILED <br /> DATA PROCESSING COPY <br />