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STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. `' ••:� ' MARK ONLY 1 NEW PERMIT 1-7 3 RENEWAL PERMIT t/ 5 CHANGE OF INFORMATION ONE ITEM 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑I 7 PEPMANENTLY CLOSED :;N El TEMPORARY TANK CLOSURE ❑ 6 TANK REMOVED Q DBA OR FACILITY NAME WHERE TANK IS INSTALLED: A 2-C-0 F-AL a S� I. TANK DESCRIPTION COMPLETE ALL ITEMS– SPECIFY IF UNKNOWN ECA. OWNER'S TANK I.D.t I –U1.►1..– 2 B. MANUFACTURED BY: Q WE�SCb2wllnly C. DATE INSTALLED(MO/DAY/YEAR) IZ�- p I D. TANK CAPACITY IN GALLONS: -- O 1Zi000 II.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. A. [–�- 1 MOTOR VEHICLE FUEL 4 OIL ito REGULAR B C. jJl/r � I 3 DIESEL ❑ UNLEADED �'"� � AViATICN GAS 2 PETROLEUM ❑ 80 EMPTY ❑w-1 PRODUCT ❑ ib PREMIUM � 4 GASAHOL _ 7 CHEMICAL PRODUCT ❑ 95 UNKNOWN 2 WASTE ❑ UNLEADED i 5 JET FUEL NETF.ANOL2 LEADED i 1' 99 OTHER (DESCRIBE IN ITEM C. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. f III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B.AND C.AND ALL THAT APPLIES IN BOX 0 AND E A. TYPE OF 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER SYSTEM ❑ g5 UNKNOWN ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL Lrl!�3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORC7PT�ASTTiC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE IJ 7 ALUMINUM ❑ 8 1001. METHANOL COMPATIBLE W/FRP (Primary Tank) 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN 99 OTHER 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR 5 GLASS LINING LINING ❑ vf6 UNLINED ❑ 95 UNKNOWN 77 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100-1. METHANOL? YES_ NO_ D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING = 3 VINYL WRAP =Ll�l FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE r--7 95 UNKNOWN _� 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) Iq 8 y OVERFILL PREVENTION EQUIPMENT INSTALLED(YEARI _ I IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION AO2 PRESSURE A U 3 GRAVITY A U 99 OTHER j B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN p U 99 OTFER C. MATERIAL AND A U i BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U FIBERGLASS PIPE _1 CORROSION A U S ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WjFRP I PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION AUTOMATIC t� AUTOMATIC LINE LEAK DETECTOR ❑y z LINE TIGHTNESS TESTING C 3 A MONITORING ❑ 99 OTHER 1 V.TANK LEAK DETEC ON =E6 L CHECK 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITCRINGTESTING �7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN � 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/OAY/YR) I 2.ESTIMATED QUANTITY OF3.WAS TANK FILLED WITH GALLON — SUBSTANCE REMAINING I YES —1 NO S INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME (PRINTED d SIGNATURE) DATE to ..1E Z-ZI •qZ� LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED 0 HE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE 1.014 ❑ = I , PERMIT NUMBER PERMIT APPROVED BY/DATE i PERMIT EXPIRATION GATE I FORM 8 (7.91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORMA,UNLESS A CURRENT FORMA HAS BEEN FILED. FOROC349-RS