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03/31/1999 11: 36 7146705420 EHS ARCO LA PALMA PAGE 05 <br /> 1. <br /> STATE Of CALIFORNIASTATE WATER WATER RESOURCES CONTROL BOARD aM <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM <br /> MARK ONLY i NEW PERMIT 0 RENEWAL PERMIT F7 5 CHANGE OF INFORMATION 77 7 PERMANENTLY CLOSED ON SITE <br /> ONE ITEM E:] 2 INTERIM PERMIT F4 AMENDED PERMIT 71 6 TEMPORARY TANK CLOSURE I-7 B TANK REMOVED <br /> DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ,SCD Z-0 <br /> 1. TANK DESCRIPTION COMPLETE ALL ITEMS— SPECIFY NKNOWN <br /> A.`owNER 9 TANK I.D.b - 8. MANUFACTURED BY: <br /> C. DATE tNsTA1.LED(M=AY/YEAR) / D. TANK CAPACITY IN GALLONS: 1C)L - '/ <br /> Qv a <br /> II.TANK CO ENTS IFA-11SMARKED,COMPLETEITEMC. <br /> 1 MOTOR <br /> VEHICLE FUEL 4 OIL D. C a 1v REGULAR 3 DIESEL 6 AVIATIONGAS <br /> A. UNLEADED <br /> 2 PETROLEUM O BO EMPTY 1 PRODUCT O 1D PREMIUM A GASAFiOL METHANOL <br /> UNLEADED ❑ 5 JET FUEL L�1 <br /> u 3 CF•IEMICAL PRODUCT 85 UNKNOWN O 2 WASTE 2 LEADED O 99 OTHER (DESCRIBE JIN ITEM O. BELOIV) <br /> D IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C,A.S. <br /> III. TANK CONSTRUCTION -MARK ONE ITEM ONLY IN BOXES A.B,AND C.AND ALL THAT APPLIES IN BOX D AND E <br /> A. TYPE OF 1 UBIE WALL 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN <br /> SYSTEM _ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAU TED TANK) 98 OTHER <br /> v n <br /> 8. TANK t BARE STEEL 2 STAINLESS STEEL 3 FIBERGLASS A STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> MATERIAL 6 CONCRETE 6 POLYVINYL CHLORIDE 7 ALUMINUM 8 100°4 METHANOL COMPATIBLE WiFRP <br /> (PtjmaryTank) 9 BRONZE O 10 GALVANIZED STEEL 95 UNKNOWN a 99 OTHER _ <br /> 1 RUB8ER LINED KYO LINING 3 EPDXY LINING 4 PHENOLIC LINING <br /> C.INTERIOR 6 GLASS LINING 6 UNLINED Q 95 UNKNOWN O 89LINING OTHER <br /> t��S LI <br /> NING MATERIAL COMPATIBLE WITH 100% METHANOL 7 YES_ NO_ <br /> D.CORROSION = LYETHVLENE WRAP a 2.COATING 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION d 91 NONE 95 UNKNOWN 99 OTHER <br /> E,SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR),e._ OVERFILL PREVENTION EOUIPMENT INSTALLED(YEAR)!! ! <br /> IV.PIPING INFORMATION CIRCLE A IF ABOVE GR DOR U IF UNDERGROUND.BOTH IF APPLICABLE <br /> A. SYSTEM TYPE A U I SUCTION A P ESSURE A U 3 GRAVITY A U 99 OTHER <br /> B. CONSTRUCTION—'- SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U y99 OTHF.F <br /> C. MATERIAL AND A BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) U FIBERGLASS PIPE y y <br /> CORROSION A U 6 ALUMINUM A U 8 CONCRETE A U 7 STEELWICOATING A U 8 1009' METHANOL COMPATIBLEW/FRP <br /> PROTECTION A U ?,GALVANIZED STEEL U 0 CATHCOI OTECTION A U 95 UNKNOWN A U 99 OTHER <br /> I D. LEAK DETECTION [ 1 AUTOMATIC LINE LEAK D 2 LINE TIGHTNESS TESTING _MONUORING ❑ 99 OTHER_--_ -V.TANK LEAK DETECTION ��AAOQUU <br /> LJ ISUAL CHECK Q 2 INVENTORY RECONCILIATION 3 VADOZE MONITORING 4 AUTOMATICTANK GAUGING <br /> 6 NC WATcR MONITOR\G <br /> Al TESTING INTERSTITIALMONITORtNG 91 NONE Q BS UNKNOWN 99 OTHER L /L <br /> VI.TANK CLOSURE INFO ATION <br /> 1-ESTIMATED DATE LAST USED(MOIDAY/YR) 2.ESTIMATE QUANTITY OF 3.WAS TANK FILLED WITH YES NO [_ <br /> 8 STA E REMAINING GALLONS INERT MATERIAL L- <br /> THIS FORM WS BEEN COMPLETED UNDER EN OF PERJURY ND TO TH BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> AP A rs NAME DATE <br /> ( I E IC ATI z� 2 <br /> LOCAL AGENC USE ONLY THE STATE I.D.NUMB COMPOSED OF THE FOUR NUMBERS BELOW <br /> COUNTY I1 JURISDICTION# FACILITY A TANK <br /> STAFF l.D.# <br /> PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE <br /> FORM B (7.01) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. <br /> FORWI48-R5 <br />