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law 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 O 7 PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ® 8 TANK REMOVED -�ry DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Sunnyside Produce W1 C/ T I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNERS TANK I.D.• ® B. MANUFACTURED BY: Unknown C. DATE INSTALLED(MODAYNEAR) Unknown D. TANK CAPACITY IN GALLONS: 10, 000 II.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. A ® t MOTOR VEHICLE FUEL ❑ 4 OIL B. C. to REGULAR UNLEADED 3 DIESEL ❑ 6 AVIATION GAS ❑ 2 PETROLEUM O 80 EMPTY ® 1 PRODUCT ❑ /b PREMNM UNLEADED 8 4 GASAHOL ❑ 7 METHANOL ❑ 1e MIDGRADE UNLEADED 5 JET FUEL ❑ 8 M85 ❑ 3 CHEMICAL PRODUCT ❑ 9S UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER(DESCRIBE IN ITEM D.BELOW) D. IF(A-1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.M: 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 ❑ i DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ® 2 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK If 1 BARE STEEL O 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (PAY TMtk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY UNING ❑ 4 PHENOLIC LINING LINING OR ❑ 5 GLASS LINING ® 8 UNLINED ❑ 95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL] YES_ NO— D.EXTERIOR O 1 POLYETHYLENE WRAP ® 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 1:195 UNKNOWN E::] 99 OTHER E SPILL AND OVERFILL,#10. SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) DROP TUBE YES NO STRIKER PLATE YES_ NO DISPENSER CONTAINMENT VES_ NO IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A(U)2 A(U)2PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A(5, 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 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U S ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WIFRP PROTECTION U B GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION E:Nt�owav4 u1E LFAX ❑z mx u ❑3 xrmsTmu ❑ IB.E�mm O 5 ww O 99 OTHIA V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ® 2 RECONCILIATION CILIATIONNUAL ORY ❑ 3 MONITORING ZE ❑ 4 AUTOMATIC C TANK ❑5 GROUND MONTORINGTER ® 8 TESTINGANNUAL ❑ 7 CCOONTINOURINGOU INTERSTITIAL ❑ 8 SIR ❑ 9 WEEKLY NK MANUAL O 10 MONTHLY TANK ❑ 95 UNKNOWN ❑99 OTHER VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATE; A/ LAST S yS D(MOIDAV(YR) 2.ESTIMATED OUANTITY OF 3.WAS TANK FILLED WITH VES ❑ C SUBSTANCE REMAINING 20 GALLONS INERT MATERIAL? EM THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJUD O THE BE F MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNER'S NAME � DATE (PRIMmdSIER NREM Keith A. Tallia-A ent 1 2/15/98 LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY k JURISDICTION# FACILITY# / � TANK# STATE I.D.# m C� � LL � ISL y PERMITNUMBER PERMIT APPROVED BVAATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATInN-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORD^MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLA' E THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UI ;ROUND STORAGE TANK REGULATIONS FORMS (6-95)