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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. 7524-35 MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED.- ITE ONE ITEM F-] 2 INTERIM PERMIT F-14 AMENDED PERMIT In 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS-- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# 7524-35-RU-2 B. MANUFACTURED BY: RHEEM C. DATE INSTALLED(MO/DAYNEAR) 1967 D. T"NK CAPACITY IN GALLONS: 5 000 ILTANKCONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. IM 1 MOTOR VEHICLE FUEL ❑ 4 OIL g, C � 1a REGULAR 3 DIESEL A. UNLEADED ❑ 6 AVIATION GAS 2 PETROLEUM BO EMPTY 1 PRODUCT 1b PREMIUM 4 GASAHOL 7 METHANOL UNLEADED 5 JET FUEL 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN 2 WASTE ❑ ❑ 2 LEADED � gg OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ❑ 1 DOUBLE WALL F-� 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN SYSTEM 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK1 BARE STEEL F-] 2 STAINLESS STEEL 3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE F-1 6 POLYVINYL CHLORIDE 7 ALUMINUM a 8 100% METHANOL COMPATIBLE W/FRP (PrimaryTank) E::] 9 BRONZE Ej 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER F-] 1 RUBBER LINED F-� 2 ALKYD LINING F-1 3 EPDXY LINING Q 4 PHENOLIC LINING C.INTERIOR F--] 5 GLASS LINING 6 UNLINED 95 UNKNOWN 99 OTHER LINING ki IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES NO D.CORROSION ❑ 1 POLYETHYLENE WRAP F-] 2 COATING O 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE 95 UNKNOWN a 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLEA IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION AA& 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION Ato 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)kiflFIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION J6 1 AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING ❑ 3 MOTERSTITIAL NITORING ❑ 99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK�NVENTORY RECONCILIATION 3 VADOZE MONITORI �p TAPI6C0ftftpQ❑ 5 GROUND WATER MONITORING 6 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE 95 UNKNOWN 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAYNR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES ❑ NO ❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPL,P70 UNDE AL N OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS RU AND CORRECT APPLICANTS NAME� DATA '� (PRINTED 8 SIGNATURE) `- /J LOCAL AGENCY USE ONLY TOE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# VO STATE LD.# LZE7 ❑m PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATEtv FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FI FOR003 11.RS