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°^ ea <br />STATE OF CALIFORNIA y e°+ <br />STATE WATER RESOURCES CONTROL BOARD". a <br />�j UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B �" <br />COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. a °"�"°"",� ' <br />MARK ONLY O 1 NEW PERMIT <br />B. <br />3 RENEWAL PERMIT <br />O 5 CHANGE OF INFORMATION <br />r 7 PERMANENTLY CLOSED ON RITF <br />ONE ITEM 0 2 INTERIM PERMIT <br />O <br />4 AMENDED PERMIT <br />6 TEMPORARY TANK CLOSURE <br />IL�JI 8 TANK REMOVED <br />DBA OR FACILITY NAME WHERE TANK IS INSTALLED: <br />DiS81V0 <br />Trucking Co. <br />MATERIAL <br />I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN <br />A. OWNER'S TANK I.D.• B. MANUFACTURED BY: Unknown <br />C. DATE INSTALLED(MO/DAY/YEAR) unknown I D. TANK CAPACITY IN GALLONS:' /bO� <br />II. TANK CONTENTS IFA-IISMARKED, COMPLETE ITEM C. <br />A O 1 MOTOR VEHICLE FUEL 4 OIL <br />B. <br />C. Q IAUNLEAD R 3 DIESEL 6 AVIATION GAS <br />O 2 PETROLEUM 0 W EMPTY <br />O 1 PRODUCT <br />O 1b PREMIUM 4 GASAHOL 7 METHANOL <br />UNLEADED Q 5 JETFUEL <br />O 3 CHEMICALPRODUCT 0 95 UNKNOWN <br />® 2 WASTE <br />2 LEADED O 99 OTHER (DESCRIBE IN ITEM D. BELOW) <br />0. IF (A.1) IS NOT MARKED, ENTER NAME OFSUBSTANCE STORED C.A.S.#: <br />III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.R.AND C. AND ALL THAT APPI IFS IN ROM D AND <br />A. TYPE OF <br />[—] 1 DOUBLE WALL <br />❑ 3 SINGLE WALL WITH EXTERIOR LINER <br />O 95 UNKNOWN <br />SYSTEM© <br />2 SINGLE WALL <br />O 4 SECONDARY CONTAINMENT (VAULTED TANK) <br />0 99 OTHER <br />B. TANK <br />Q 1 BARE STEEL <br />O 2 STAINLESS STEEL <br />0 3 FIBERGLASS <br />O 4 STEELCLAD W/ FIBERGLASS REINFORCED PLASTIC <br />MATERIAL <br />O 5 CONCRETE <br />F1 6 POLYVINYL CHLORIDE <br />O 7 ALUMINUM <br />O 8 100% METHANOL COMPATIBLE W/FRP <br />(PrimaryTank) <br />E:j 9 BRONZE <br />O 10 GALVANIZED STEEL <br />O 95 UNKNOWN <br />O 99 OTHER <br />O / RUBBER LINED <br />O 2 ALKYD LINING <br />F7 3 EPDXY LINING <br />O 4 PHENOLIC LINING <br />C. INTERIOR <br />LINING <br />O 5 GLASS LINING <br />® 6 UNLINED <br />95 UNKNOWN <br />0 99 OTHER <br />PROTECTION <br />IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL ? <br />YES_ NO— <br />A U <br />D. CORROSION <br />1 POLYETHYLENE WRAP <br />4 2 COATING <br />-Q <br />O 3 VINYL WRAP <br />O 4 FIBERGLASS REINFORCED PLASTIC <br />PROTECTION <br />Q 5 CATHODIC PROTECTION <br />91 NONE <br />O95 UNKNOWN <br />99 OTHER <br />E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) <br />OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) <br />IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND, BOTH IF APPLICABLE <br />A. SYSTEM TYPE <br />A U <br />1 SUCTKON <br />A U <br />2 PRESSURE A U <br />3 GRAVITY <br />A U 99 OTHER <br />B. <br />CONSTRUCTION <br />A U <br />1 SINGLE WALL <br />A U <br />2 DOUBLE WALL A U <br />3 LINED TRENCH <br />A U 95 UNKNOWN A U 99 OTHER <br />C. <br />MATERIAL AND <br />A U <br />1 BARE STEEL <br />A U <br />2 STAINLESS STEEL A U <br />3 POLYVINYL CHLORIDE (PVC) A U <br />4 FIBERGLASS PIPE <br />CORROSION <br />A U <br />5 ALUMINUM <br />A U <br />6 CONCRETE A U <br />7 STEEL W/COATING <br />A U <br />8 100% METHANOL COMPATIBLE W/FRP <br />PROTECTION <br />A0 <br />9 GALVANIZED STEEL <br />A U <br />10 CATHODIC PROTECTION <br />A U 95 UNKNOWN <br />A U <br />99 OTHER <br />D. <br />LEAK DETECTION <br />01 <br />AUTOMATIC LINE LEAK <br />DETECTOR ® 2 LINE TIGHTNESS TESTING 3 <br />INTERSTITIAL <br />99 OTHER <br />MONITORING <br />V. TANK LEAK DETECTION <br />0 1 VISUAL CHECK 0 2 INVENTORY RECONCILIATION O 3 VADOZE MONITORING O 4 AUTOMATIC TANK GAUGING 5 GROUND WATER MONITORING <br />6 TANK TESTING O 7 INTERSTITIAL MONITORING O 91 NONE O 95 UNKNOWN O 99 OTHER <br />1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF <br />3/1/92 SUBSTANCE REMAINING <br />THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF)KRJUPJ <br />APPLICANT'S NAME <br />IPRINTEO851GNATUREI John S. Tunger,- , <br />100 GALLONS I 3. WASITANK FILLEDNERTMATERIALI?H YES ] NO Q <br />)TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br />1 1 1DATE <br />3/5/92 <br />LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS P SED OF THE FOUR NUMBERSMELOW <br />COUNTY # J IS CTION # FACILITY # TANK # i6L SAL I <br />STATE I.D.# 5TOX 6 3 6 0 LJl <br />IPERMITNUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE p `I -PLS <br />FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION -FORMA, UNLESS A CURRENT FORMA HAS BEEN FILED. <br />FOANNI <br />\I00, <br />