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• • y /y� ��.00-c�T STATE OF CALIFORNIA _ STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B ry; a COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM `'� -•" MARK ONLY ❑ 1 NEW PERMIT 0 RENEWAL PER CHANGE OF INFORMATION Ik��' 7 PERMANENTLY ONE ITEM ❑ 2 INTERIM PERMIT ❑ a AMENDED PERMIT ❑ g TEMPORARY TANK CLOSURE I�[I B TANK REMOVED D DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 9033 VA L ::L r� 7� ,� _h 3 I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN I` ! IC WK 1.D.a 8. MANUFACTURED By-.- C. Y:C. DATE INSTALLED(MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: ILTANKCONTENTS IFA•I IS MARKED.COMPLETE ITEM C. A. 1 MOTOR VEHICLE FUEL ❑ a OIL 8. / C. Ia R5GU R 8 0 DIESEL ❑ g AyIATION GAS ❑ 2 PETROLEUM F-180 EMPTY 1 PRODUCT ❑ ib PREMIUM ` GASAHOL UNLEADED 5 .IETFUEL ❑ 7 METHANOL ❑ 7 CHEMICAL PRODUCT El 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED % OTHER (DESCRIBE IN ITEM D. BELOW) 0. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.a: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.S.AND C.AND ALL THAT APPLIES IN BOX 1) A. TYPE OF ❑ 1BLE WALL ❑ 0 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM 2 SINGLE WALL ❑ l SECONDARY CONTAINMENT (VAULTED TANIq ❑ 90 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 0 FIBERGLASS ❑ a STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 109% METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER C.INTERIOR ❑ I RUBBER LINED 2 ALKYD LINING ❑ 5 OXY LINING ❑ d PHENOLIC LINING LINING ❑ 5 GLASS LINING 8 UNLINED 95 UNKNOWN 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES_ NO— D.CORROSION ❑ i POLYETHYLENE WRAP ❑ 2 COATING 0 3,VfhYL WRAP ❑ a FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U S GRAVITY A U 99 OTHER NS. CONSTRUCTION A U I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 0 POLYVINYL CHLORIDE(PVC)A U a FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 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 ❑ 1 AUTOMATIC LINE LEAK DETECTOR 2 LINETIGHTNESS TESTING ❑ MONRORWG ❑ OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 9 VAPOR MONITORING❑ d AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING N ❑ 8 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAWYR) I 2.ESTIMATED OUANTITY OF 2.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL YES ❑ No THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME (PRINTED 6 SI9NATUPRI DAT:'�4- OSED LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER S COMPOF THE FOUR NUMBERS BE W COUNTY 9 JURISDICTION• TANK 9 I TATE I.D. PERMIT NUMBER PERMIT APPROVEY T MITEXPIRATION DATE 7i FORM 8 (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. �M o FOMMS-M