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STATE OF CALIFORNIf WATER RESOURCES CONTRO 'OARD 4,Ott)SV. aJ FORM `B9. UNDERGROUND STORAGE TANK PROGRAM TANK TANK PERMIT APPLICATION INFORMATION COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. b MARK ONLY ❑ I NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ � PERMANENTLY C4 OSED TAN -� ONE ITEM ❑2 INTERIM PERM(T ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED IA FACILITY/SITE NAME WHERE TANK IS INSTALLED: f S 33 Trac FARM TANK-YES❑ IND 1. TANK DESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN—SO SPECIFY • A. OWNERS TANK IDM ,V1 B. MANUFACTURED BY. Wyti — C. YEAR INSTALLED D. TANK CAPACITY IN GALLONS, 11. TANK CONTENTS IF(A.1),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. TOR VEHICLE ESEL A ❑ 3 Cf CHEMICAL PR DUCTL ❑ 4 OIL PETROLEUM B 1 PRODUCT C ❑ 4 GASH OED ❑ 5 J�UEI ❑ 6 AVIATION GAS ❑ 5 HAZARDOUS ❑ 80 EMPTY ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN ITEM 0,BELOW) D. IF NOT MOTOR VEHICLE FUEL,ENTER NAME OF HAZARDOUS SUBSTANCE STORED&C.A.S.M C.A.S.M: 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,B,C.i D A TYPE OF ❑ I DOUBLE WALLED 3 SINGLE WALLED WITH EXTERIOR LINER95 UNKNOWN SYSTEM ❑2 SINGLE WALLED ❑4 sECONDARYCONTAINMEPIT ❑ 99 OTHER ❑ 1 STEEL/IRON ❑2 STA1NLMSTEEL ❑ 3 FIBEMLASS ❑ 4 STEE!CLADW/RBERGLASSREINFORCEDPLASIC B. TANK ❑ MATERIAL 5 CONCRETE ❑6 POLYVINYL CHLOFMF ❑ ?ALUMINUM ❑ 6 1O3%METHANOL GOMPADBLE FRP ❑ 9 BRONZE ❑ 10 GALVANIZED8TMEL 95 UNKNOWN ❑99 OTHER G INTERIOR F-11 RUBBER LINED ❑2 ALKYD LINING ❑3 EPDXY UNNNG ❑4 PHENOLIC LINING LINING ❑ 5 GLASS'JNING ❑ 6 UNL9uE0 5UUNKNOWN ❑ IS LNNG MATERAL COMPATIBLE WITH 100%METHANOL? ❑YES ❑ NO ❑99 OTHER D.CORROSION ❑ I POLYETHLENE WRAP ❑2 TAR N ASPHALT ❑ 3 VINYL WRAP ❑4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑91 NOW 95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND, U IF UNDERGROUND,BOTH IF APPLICABLE A SYSTEM TYPE A U i SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 9, NONE A rL19 UNKNOWN A U 99 OTHER B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 91 NONE A(J95 UNKNOWN A U 99 OTHER A U 1 STEEL/IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U 4 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 8 100%METHANOL COMPATIBLE FRP A U 9 GALVANIZED STEEL A (Z�5 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 8 1 VISUAL CHECK P 6 2 INVENTORY RECONCILIATION P 8 3 VADOSE WELLS P S 4 ELECTRONIC MONITOR P S 5 GROUND WATER MONITORING WE_LS P 5 6 PRECISION TESTING P S ' PRESSURE TESTING P S 91 NONE P 6 95 UNKNOWN P S 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1 ESTIMATED DATE LAST USED(MO/YH) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING IN GALLONS INERT MATERIAL? ❑YES ❑ NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT APPLICANTS NAME(PRINTED 6 SIGNATURE) DATE LOCAL AGENCY USE ONLY COUNTY,-# JURISDICTION Y AGENCY M FACILITY ID M TANK 1D M 1LI � CURRENT LOCAL AGENCY FACILITY ID 9 APPROVED BY NAME PHONE#WITH AREA CODE 7-K/ PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE CHECK i PERMOT AMOUNT �BuAMT. FEE CODE RECEIPT A FORM 8(6-29-88) THIS FORM MUST BE ACCOMPAN, .Y A FACILITY/SITE APPLICATION. FORM 'A'.UNLESS A cJRRENT FORM'r N!S RFFN FII F11