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ze°�^ e <br />STATE OF CALIFORNIA �O* <br />STATE WATER RESOURCES CONTROL BOARD i° <br />UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B w �� Y <br />=. yam. � '� <br />COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br />MARK ONLY O 1 NEW PERMIT O <br />3 RENEWAL PERMIT <br />B. <br />1 PRODUCT <br />O 2 WASTEO <br />5 CHANGE OF INFORMATION <br />O <br />7 PERMANENTLY CLOSE" "USS" <br />ONE ITEM O 2 INTERIM PERMIT 0 <br />4 AMENDED PERMIT <br />0 <br />6 TEMPORARY TANK CLOSURE.. <br />O 2 STAINLESS STEEL <br />8 TANK REMOVED/!lr / <br />c�/� <br />DBA OR FACILITY NAME WHERE TANK IS INSTALLED: <br />n Sal Vo Tru <br />r iin13 <br />Co_ <br />F7 7 ALUMINUM <br />O 8 100% METHANOL COMPATIBLE W/FRP <br />I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN <br />A. OWNER'S TANK I.D.# B. MANUFACTURED BY: <br />11 i(nTlYT1 <br />C. DATE INSTALLED(MO/DAY/YEAR) unknnwn I <br />D. TANK CAPACITY IN GALLONS: 19-000 <br />1?_000 <br />ILTANKCONTENTS IFA -1 IS MARKED. COMPLETE ITEM C. <br />A 1 MOTOR VEHICLE FUEL <br />2 PETROLEUM <br />0 3 CHEMICALPRODUCT <br />O 4 OIL <br />O 00 EMPTY <br />0 95 UNKNOWN <br />B. <br />1 PRODUCT <br />O 2 WASTEO <br />C. 1. REGULAR <br />EGU R <br />ib PREMIUM <br />UNLEADED <br />2 LEADED <br />3 DIESEL 6 AVIATION GAS <br />4 GASAHOL 7 METHANOL <br />8JL <br />O 8 OTHER DESCRIBE IN ITEM D. BELOW) <br />D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED <br />O 4 SECONDARY CONTAINMENT (VAULTED TANK) <br />99 OTHER <br />B. TANK <br />C. A. S. a: <br />III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. R AND AND AL L THAT APPI IFS IN ROY n ANnP <br />A. TYPE OF <br />O 1 DOUBLE WALL <br />O 3 SINGLE WALL WITH EXTERIOR LINER <br />95 UNKNOWN <br />SYSTEM <br />2 SINGLE WALL <br />O 4 SECONDARY CONTAINMENT (VAULTED TANK) <br />99 OTHER <br />B. TANK <br />1� <br />4y 1 BARE STEEL <br />O 2 STAINLESS STEEL <br />O 3 FIBERGLASS <br />4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC <br />MATERIAL <br />O 5 CONCRETE <br />F7 6 POLYVINYL CHLORIDE <br />F7 7 ALUMINUM <br />O 8 100% METHANOL COMPATIBLE W/FRP <br />(PrimaryTank) <br />O 9 BRONZE <br />O 10 GALVANIZED STEEL <br />0 95 UNKNOWN <br />O 99 OTHER <br />4 FIBERGLASS PIPE <br />8 100% METHANOL COMPATIBLE W/FRP <br />99 OTHER <br />O 1 RUBBER LINED <br />O 2 ALKYD LINING <br />O 3 EPDXY LINING <br />O 4 PHENOLIC LINING <br />C. INTERIOR <br />O 5 GLASS LINING <br />® 6 UNLINED <br />❑ 95 UNKNOWN <br />0 99 OTHER <br />LINING <br />IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? <br />YES_ NO— <br />D. CORROSION <br />1 POLYETHYLENE WRAP <br />2 COATING <br />3 VINYL WRAP <br />a 4 FIBERGLASS REINFORCED PLASTIC <br />PROTECTION <br />5 CATHODIC PROTECTION <br />Q 91 NONE <br />O95 UNKNOWN <br />O 9g OTHER <br />E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) <br />OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) <br />IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE <br />A. <br />SYSTEM TYPE <br />A U <br />1 SUCTION <br />Q <br />2 PRESSURE A U <br />3 GRAVITY <br />A U 99 OTHER <br />B. <br />CONSTRUCTION <br />Ag <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 />CORROSION <br />PROTECTION <br />A U <br />A U <br />A U <br />1 BARE STEEL <br />5 ALUMINUM <br />9 GALVANIZED STEEL <br />A U <br />A U <br />A U <br />2 STAINLESS STEEL A U <br />6 CONCRETE A U <br />10 CATHODIC PROTECTION <br />3 POLYVINYL CHLORIDE (PVC)A U <br />7 STEEL W/COATING A U <br />A U 95 UNKNOWN A U <br />4 FIBERGLASS PIPE <br />8 100% METHANOL COMPATIBLE W/FRP <br />99 OTHER <br />D. <br />LEAK DETECTION <br />O 1 <br />AUTOMATIC LINE LEAK DETECTOR ® 2 LINE TIGHTNESS TESTING ❑ 3 <br />MONITORING <br />Egg OTHER <br />V. TANK LEAK DETECTION <br />1 VISUAL CHECK Q 2 INVENTORY RECONCILIATION 0 3 VADOZE MONITORING 0 4 AUTOMATIC TANK GAUGING 5 GROUND WATER MONITORING <br />6 TANK TESTING O 7 INTERSTITIAL MONITORING O 91 NONE O 95 UNKNOWN 99 OTHER <br />VI. TANK CLOSURE INFORMATION <br />1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 1 3. WAS TANK FILLED WITH YES O NOlqp L� <br />SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 R-� <br />THIS FORM HAS BEEN COMPLETED UNDER PENAL F PERJY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br />APPLICANTS NAME DATE <br />IPRINTEDA SIGNATURE) John S. Tunger C Z 3/5/927 <br />LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER MPOSEO OF THE FOUR NUMBERS ELOW J <br />COUNTY # J IBDICTION # FACILITY # TANK # IS ALI Y <br />STATE I.D.# ® 6 $ 3 b 0 2 <br />PERMITNUMBER PERM IT APPROVED BY/DATE PERMIT EXPIRATION DATE -i y-2) <br />FORM R (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION • FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. <br />FORO¢u&�A1 <br />