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%m/ STATE OF CALIFORNIA a <br />STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM BCOMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br />MARK ONLY O 1 NEW PERMIT 0 <br />3 RENEWAL PERMIT O 5 CHANGE OF INFORMATION <br />0 <br />7 PERMANENTLY CLOSED ON SITE <br />ONE ITEM 0 2 INTERIM PERMIT O <br />4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE <br />® <br />8 TANK REMOVED 07 <br />DBAOR FACILITY NAME WHERE TANK IS INSTALLED: <br />D1Se1Vo Trucking Co. <br />F-1 2 STAINLESS STEEL <br />O 3 FIBERGLASS <br />I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN <br />A. OWNERS TANK I.D.# 'S B. MANUFACTURED BY: unknown <br />C. DATE INSTALLED(MO/DAY/YEAR) unknown D. TANK CAPACITY IN GALLONS: 12.000 <br />ILTANKCONTENTS IFA -11S MARKED. COMPLETE ITEM C. <br />A ® 1 MOTOR VEHICLE FUEL 4 OIL <br />B. <br />C. 1aREGULAR UNLEADED 3 DIESEL 6 AVIATIONGAS <br />a 2 PETROLEUM O SO EMPTY <br />® 1 PRODUCT <br />O IbPREMIUM 4 GASAHOL 7 METHANOL <br />UNLEADED O L <br />O 3 CHEMICALPRODUCT O 95 UNKNOWN <br />Q 2 WASTE <br />E]2 LEADED 9 9 OTHER (DESCRIBE IN ITEM D. BELOW) <br />O <br />D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C. A. S. a: <br />III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B.AND C. AND ALL THAT APPLIES IN BOX D AND <br />A. TYPE OF <br />O 1 DOUBLE WALL <br />F--1 3 SINGLE WALL WITH EXTERIOR LINER <br />E:l 95 UNKNOWN <br />SYSTEM <br />® 2 SINGLE WALL <br />E] 4 SECONDARY CONTAINMENT (VAULTED TANK) <br />0 99 OTHER <br />B. TANK <br />® 1 BARE STEEL <br />F-1 2 STAINLESS STEEL <br />O 3 FIBERGLASS <br />O 4 STEELCLAD W/ FIBERGLASS REINFORCED PLASTIC <br />MATERIAL <br />a 5 CONCRETE <br />O B POLYVINYL CHLORIDE <br />O 7 ALUMINUM <br />O 8 100% METHANOL COMPATIBLE W/FRP <br />(Primary Tank) <br />0 9 BRONZE <br />O 10 GALVANIZED STEEL <br />O 95 UNKNOWN <br />O 99 OTHER <br />4 FIBERGLASS PIPE <br />8 109% METHANOL COMPATIBLE W/FRP <br />99 OTHER <br />0 1 RUBBER LINED <br />O 2 ALKYD LINING <br />3 EPDXY LINING <br />O 4 PHENOLIC LINING <br />C. INTERIOR <br />LINING <br />0 5 GLASS LINING <br />® 6 UNLINED <br />O 95 UNKNOWN <br />0 99 OTHER <br />IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? <br />YES_ NO— <br />D. CORROSION <br />O 1 POLYETHYLENE WRAP <br />® 2 COATING <br />O 3 VINYL WRAP <br />E] 4 FIBERGLASS REINFORCED PLASTIC <br />PROTECTION <br />= 5 CATHODIC PROTECTION <br />Q 91 NONE <br />Q 95 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. <br />SYSTEM TYPE <br />A U <br />1 SUCTION <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 B9 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 />8 109% METHANOL COMPATIBLE W/FRP <br />99 OTHER <br />D. <br />LEAK DETECTION <br />O 1 <br />AUTOMATIC LINE LEAK DETECTOR ® 2 LINE TIGHTNESS TESTING ❑ 399 <br />IAONRORING <br />OTHER <br />V. TANK LEAK DETECTION <br />I VISUAL CHECK 0 2 INVENTORY RECONCILIATION 0 3 VADOZE MONITORING Q 4 AUTOMATIC TANK GAUGING O 5 GROUND WATER MONITORING <br />6 TANK TESTING 0 7 INTERSTITIAL MONITORING F-I 91 NONE O 95 UNKNOWN O 99 OTHER <br />1. ESTIMATED DATE LAST USED(MO/DAY/YR) 2. SUB( STANC6UANTIITY O 1OO GALLONS( 3. WAS TAN FILLED <br />DWIITH YES O NO Er <br />3/1/92 <br />THIS FORM HAS BEEN COMPLETED UNDER PENAL F PE URY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br />APPLICANTS NAME DATE <br />(PRINTED& SIGNATURE) John S. TOnger ,, „ �� 3/5/92 <br />LOCAL AGENCY USE ONLY THE STATE I.D. NUMBS I COMPOSED OF THE FOUR NU RS BELOW <br />COUNTY # VJURISDICTION IN FACILITY # TANK # <br />STATE I.D.# m F M ©1114 015 <br />PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE <br />�-- <br />FORM a (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORMA, UNLESS A CURRENT FORMA HAS BEEN FILED. <br />FOROOkBL15 <br />`/ `/ <br />