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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 ONSITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 6 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ARCO 707 \0 (9 6�js Sro CV'10 N I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWN , TANK I.D.t 2, B. MANUFACTURED BY. xe(�XeS C. DATE INSTM l m(AO/DAY/YEAR) 3 1 9 D. TANK CAPACITY IN GALLONS: 2 U Il.TANK CONTENTS IF A•1 IS MARKED,COMPLETE ITEM C. ,L 0 1 MOTOR VEHICLE FUEL ❑ 4 OIL B, C. g to REGULAR UNLEADED ❑ 3 DIESEL [:] 6 AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY �1 PRODUCT 1e PREMIUM UNLEADED ❑ 4 GASAHOLn 7 METHANOL lc MOGRADE UNLEADED 5 JETFU0. IH B M85 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE 2 LEADED 99 OTHER(DESME W ITEM D.BELOW) D. IF(At)IS NOT MARKED. env; NAME OF SUBSTANCE STORED C.A S Y 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 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR UNER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL tEr 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100%METHANOL COMPATIBLE W/FRP M1i1"Tmk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER UNED ❑ 2 ALKYD LINING ❑ 3 EPDXY UNING ❑ 4 PHENOUC LINING LINING OR ❑ 5 GLASS LINING 6 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO— D.EXTERIOR ❑ 1 POLYEfHYLEE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC CORROSION PRoTECAON ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑ 99 OTHER E SPILL AND OVERFlll,etc. SPILL CON TAINMENTINSfALLE"(YEAR) OVERFILL PREVENf10N EQUIPMENT INSTALLED(VEAR)� DROP TUBE YES_/ NO_ STRIKER PLATE YES_✓ NO_ DISPENSER CONTAINMENT YES_ NO— M PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.BOTH IF APPUCABLE A. SYSTEM TYPE A U 1 SUCTION AW 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER G MATERIAL AND A U 1 BARE STEEL A U 2 STAWLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ®t IcqurecAL LNE IMAX ❑z 1ramFss 3 wxnw u xremm�u ❑4 uraE s nc rule ❑ w OTHe V,TANK LEAK DETECTION ❑ 1 VISUAL CHECK E] 2 MANUAL I INVENTORY _❑ 3 M�ORING ED AAUUTOMAG C TANK ❑5 GROUND ING� ❑6 ANNUAL TANK RECONCTESTIN 7 OOON�TINUOUI INTERSTITIAL E 8 SIR- ❑ 9 T�AlM NGAL ❑10 �ONTHCY TANK ❑ 95 UNKNOWN ❑ 99 OTHER STIN VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE INaLACE) 1.ESTIMATED DATE LAST USED(MCMAYAIF 2.ESTIMATED QUANTITY OF 3.WAS TANK RLLED WITH YES ❑ NO❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL 4 THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT TANK OWNERS NAME ! DATE 1 p� (PWITEDASKiNATURq LOCAL AGENCY USE ONrY THE STATE I.D.NUMB 1S COMPOSED OF THE FOUR NUMBERS OW COUNTY IT JURISDICTION M FACILITY KI TANK NOD STATE I.D.# FT-1 -7 ?- F it= (� El 1 ,L 1 3 PERMIT NUMBER. PERMIT APPROVED BY/DATE PERMIIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT TION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FMLC MUST BE COMPLETED FOR INSTALLATIONS THIS FORM SHOULD BE ACCOMPANIED BY A PLOT P RLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THlqWGROUND STORAGE TANK REGULATIONS FORM B (695)