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u.� STATE OFCAUFORNIA STATE WATER RESOURCES CONTROL BOARD �a UNDERGROUND STORAGE TANK PERMIT APPLICATION -FORM B �� = COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY O I NEW PERMIT O 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION O 7 PERMANENTLY CLOSED ON I ONE ITEM O 2 INTERIM PERMIT O 0 AMENDED PERMIT O6 TEMPORARY TANK CLOSURE ® B TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Sunnyside PD'odu Ce I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A- OWNERS TANK 1.D.0 03 8. MANUFACTURED BY: Unknown C. DATE INSTALLED(MOIDAWYEAR) Unknown D. TANK CAPACITY IN GALLONS: 10, 000 0 00 ILTANK CONTENTS IFA-11S MARKED,COMPLETE ITEM C. p ® 1 MOTOR VEHICLE FUEL ❑ { OIL B. C. lA REGUWIUNLEADED 3 DIESEL ❑ e AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY ® 1 PRODUCT ❑ I5 PREMIUM UNLEADED { GASAHOL ❑ 7 METHANOL ❑ Ic MOGRFDE UNLEADED 5 JET FUEL Q 8 M85 O 3 CHEMICAL PRODUCT 95 UNKNOWN ❑ 2 WASTE E:] 2 LEADED 8B OTHER(DESCRIBE W ITEM D.BELOW) O. IF(A1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A S.I: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.8,AND C.AND ALL THAT APPLIES IN BOX D AND E 1 DOUBLE WALL EXTERIOR UNER 3 SINGLE WALL WITH A. TYPE OF ❑ ❑ 5 INFERNAL BLADDER SYSTEM ❑ % UNKNOWN SYSTEM [IK]7 2 SINGLE WALL El { SINGLE WALL IN A VAULT F-199 OTHER 10 B. TANK 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ { STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL O 5 CONCRETE O 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM a 8 100% METHANOL COMPATIBLE WIFRP (Primary Twk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ I RUBBER UNED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING O 0 PHENOLIC LINING LINING OR a 5 GLASS LINING ® B 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 CATHODICPROTECTION ❑ 91 NONE E�J 95 UNKNOWN ❑ 99 OTHER E SPILL AND OVERFILL, 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 ABOVUN ROD OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U { FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 UNED 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 CORROSIONA 5 ALUMINUM A U B CONCRETE A U 7 STEEL W/COATING A U B 100% METHANOL COMPATIBLE WIFRP PROTECTION A U B GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ®1 OETHT011YEOUId ME IFAR a 2 UK TKA9IF35 3 CONIAIUWS INTBt5TI1LLL {FLECfROME UN: O 5 AUfO TK PUP ❑ 99 OTHER TESIN9 MONT09NB UW OEIECTOR 9Nf00WX V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ® 2 MANUAL RECONCILIATIONINVENT ❑ 3 VOZE MAODNIITORING ❑ { GAUD NG MATIC TANK E::] 5 MONITORING GROUND WATER �e ANNUAL TESTINGTANK ❑ 7 ICOONTINNUU ❑ E:]UU SINTERSTITIAL B SIR 9%KGAUGINGAL ❑ 10 MONTHLY TANK O 95 UNKNOWN ❑99 OTHER INGTESTING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 1.ESTIMATED DATE LAST USED(MOIDAYIYR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH VES ❑ NO)o 1 2/2 0 9 8 SUBSTANCE REMAINING 2 O GALLONS INERT MATERIAL 7 THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY O THE BEST OF NOWLEDGE,IS TRUE AND CORRECT TANK OWNER'S NAME DATE (PRINTD3A51GNATURLT Keith A. Tallia A ent 12/15 98 LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSE OF THE FOUR NUMBERS BELOW COUNTY 9 JURISDICTION N FACILITY k TANK A STATE 01 m 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 PL' 'ILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE I- -RGROUND STORAGE TANK REGULATIONS FORM B (6-95)