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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 ITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 0 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE © B TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Sunnyside Produce O ! V , I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNER'S TANK I.D.f ; B. MNUFACT IRED BY: Unknown C. DATE INSTALLED(MOMAY/YEAR) Unknown D. TANK CAPACITY IN GALLONS: 10 000 II,TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. ® 1 MOTOR VEHICLE FUEL ❑ 6 OIL B. 1–q C. to PEGULAP UNLEADm 3 DIESEL ❑ 6 AVIATION GAS A ❑ 2 PETROLEUM ❑ SO EMPTY 1 •� 1 PRODUCT 0 10 PREMIUM UNLEADED g 4 GASNOL ❑ ] METHANOL ❑ le MDGMDE UNLEADED n�j 5 JET FUEL ❑ e MBS ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED u 99 DTHEAIDESCRIBEINMEMD.BELOM D. IF(Al)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A S. 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.8,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ® 2 SINGLE WALL ❑ < SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK ® 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ I STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (PHR1ry Tmk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER UNED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC 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 POLYETHYLENE WRAP © 2 COATING ❑ 3 VINYL WRAP ❑ < FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑ 99 OTHER E SPILL AND OVERFILL,e1C. SPILL CONTAINMENT INSTALLED(YEAR) IOVERFILL PREVENRON EQUIPMENT INSTALLED(YEN) DROP TUBE YES NO STRIKER PLATE YES_ NO DISPENSER CONTAINMENT YES_ NO IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND,BOTH IFAPPUCABLE A. SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U A FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION U 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 U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U < FIBERGLASS PIPE CORROSION AbS ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑EgI 1Eclumou UNE LTAX 2 MI< S!I D 3[X=N.S IxlEmm�u A =KN:HC U5 MO.= 11 [XnaM ❑ TFSIW9 WMITMING ❑ tFMf 9ElEfTOR SINIIWWX PUMP ❑ 99 OTHER V.TANK LEAK DETECTION '(� F-11 VISUAL CHECK IJ 2 RECONCILIATION UATIONORY ❑ 3 MONITORING ❑ A AUTOMATIC TANK ❑5 GROUNDWATER ROUND W TER ®6 ANNUAL ❑ ] CONTNUOUSITORING INTERSTITIAL ❑ 8 SIR ❑ 9 TANEK GAUGIN UAL E:]10 MONTHLY TANK ❑ 95 UNKNOWNMON ❑ 99 OTHER TING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DAT LP$T,U$EQ(MOTAY/YR) 2'F-SSUTIMATED QUANTITY OF BSTANCE REMAINING 20 GALLONS 3 WAS I ERT MATERIAL? TANK FILLED H YES ❑ NO THIS FORM HALS/BEEN`�C20SMPLETED UNDER PENALTY OF PERJ ,AND THE BEST OF NOWLEDGE,IS TRUE AND CORRECT TNK OWNER'S NAME DATE (PR KO SK9uTuatT Keith A. Ta 11ia1A ent 12/15/98 LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED F THE FOUR NUMBERS BELOW COUNTY M JURISDICTION# FACILITY k TANK N STATE I.Dl m = I n11111.5 121101 ON 1,/t q PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS.THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLI 'LE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE V 1GROUND STORAGE TANK REGULATIONS FORM B (6-95) %IW