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STATIC OF CALIFORNIA WATER RESOURCES CONTROL BOARD r6RM 'B': UND a'ROUND STORAGE TANK PR( RAM A „ COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. MARK ONLY ® 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTL ONE ITEM ❑ 2 INTERIM PERMIT 714 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLO URE 8 TANK REMOVE FACILITY/SITE NAME WHERE TANK IS INSTALLED: S S S (M QlJ ARM TANK -YES ❑ NO °. TANK DESCRIPTION COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. OWNERS TANK ID # f ' B. MANUFACTURED BY: Xerxes C. YEAR INSTALLED 1990 1 D. TANK CAPACITY IN GALLONS: 10 , 000 11. TANK CONTENTS IF (A.1), IS MARKED, COMPLETE ITEM C. IF (A.1), IS NOT MARKED, COMPLETE ITEM D. A. 1 MOTOR VEHICLE FUEL ❑ 2 PETROLEUM B. C.1 UNLEADED ❑ 2 LEADED ❑ 3 DIESEL ❑ 3 CHEMICAL PRODUCT ❑ 4 OIL 12 1 PRODUCT n4 GASAHOL ❑ 5 JET FUEL ❑ 6 AVIATION CAS ❑ 5 HAZARDOUS ❑ 80 EMPTY ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 7 METHANOL ❑ 99 OTHER (DESCRIBE IN ITEM D, BELOW) D. IF NOT MOTOR VEHICLE FUEL, ENTER NAME OF HAZARDOUS SUBSTANCE STORED & C.A.S. # C.A.S. #: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A, B, C, & D A. TYPE OFX SYSTEM 1 DOUBLE WALLED ❑ 2 SINGLE WALLED ❑ 3 SINGLE WALLED WITH EXTERIOR LINER ❑ 4 SECONDARY CONTAINMENT ❑ 95 UNKNOWN 99 OTHER A U 3 GRAVITY A U 91 NONE ❑ i STEEL/IRON ❑ 2 STAINLESS STEEL ® 3 FIBERGLASS ❑ 4 STEEL CLADW/FIBERGLASS REINFORCED PLASTIC A O 2 DOUBLE WALLED B. TANK ❑ 5 CONCRETE ❑ 6 POLYVINYLCHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE FRP U 1 STEEL/IRON MATERIAL ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN 99 OTHER A U 5 ALUMINUM ❑ 1 RUBBER LINED F-12 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C. INTERIOR LINING ❑ 5 GLASS LINING ❑ 6 UNLINED U 99 OTHER ❑ 95 UNKNOWN D. CORROSION MIS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? ❑ 1 POLYETHLENE WRAP ❑ 2 TAR OR ASPHALT YES ❑ NO ❑ 3 VINYL WRAP ❑ 99 OTHER 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑ 95 UNKNOWN 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND. U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U 91 NONE A U 95 UNKNOWN A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALLED A O 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A U 95 UNKNOWN A U 99 GTHER A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A04 FIBERGLASS PIPE A U 91 NONE C. MATERIAL A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL CLAD W/FRP A U 6 100% METHA140L COMPATIBLE FRP A U 9 GALVANIZED STEEL A U 95 UNKNOWN A U 99 OTHER V. LEAK DETECTION SYSTEM CIRCLE P FOR PRIMARY, OR S FOR SECONDARY, A PRIMARY LEAK DETECTION SYSTEM MUST BE CIRCLED. P S 1 VISUAL CHECK Pd 2 INVENTORY RECONCILIATION P S 3 VADOSE WELLS (ED 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WELLS P S 6 PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN rp-)S 99 OTHER ` ed Jacket PLD VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED (MO/YR) ESTIMATED OUANTITY OF 3. WAS TANK FILLED WITH N /A � SUBSTANCE REMAINING IN INERT MATERIAL? ❑YES i\0 N /A GALLONS rj /A k,y THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. Af FLI�;Aa NAME (F'FtINTtU G SICiNAI URE) DATE Frances W. Hedric -C Agent for ARCO LOCAL. AGENCY USE ONLY Barghausen Consulting Engineers, Inc. (916) 348- COUNTY # JURISDICTION # AGENCY t' FACILITY ID # TANK ID P. 3U.57 [T-il I I I I _I I I I I dl o F/ 1-71 o I P] ol o lo I � HONE # WITH AREA CODE BY: CURRENT LOCAL AGENCY FACI ITY ID k / APPROVED BY NAME P PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE CHECK # I PERMIT AMOUNT I SURCHARGE AMT. FEE CODE I RECEIPT # FORM B (6-29-88) THIS FORM MUST BE ACCOMPv .,J BY A FACILITY/SITE APPLICATION, FORM 'A', UNLESa .: CURRENT FORMAHAS BEEN FILED L)1111T A PROCESSN".IG COPY