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0 Sp VRCES <br /> STATE OF CALIFORNIA ?Pt c°1 <br /> STATE WATER RESOURCES CONTROL BOARD w , <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B x <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br /> MARK ONLY ❑ 1 NEW PERMIT 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON SITE <br /> ONE ITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED <br /> DBA OR FACILITY NAME WHERE TANK IS INSTALLED: BP OIL. lFAQLfTY # 193 <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN <br /> A. OWNER'S TANK 1.D. B. MANUFACTURED BY: VNIWdWN <br /> C. DATE INSTALLED(MO/DAY/YEAR) I91s D. TANK CAPACITY IN GALLONS: aPoo <br /> II.TANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. PLUS <br /> A. 1 MOTOR VEHICLE FUEL 4 OIL B. C. ❑ UNLEA1a IXG;; IED ❑ 3 DIESEL 6 AVIATION GAS <br /> 2 PETROLEUM El 80 EMPTY 1 PRODUCT O tbPREMIUM ❑ 4 GASAHOL 7 METHANOL <br /> UNLEADED ❑ 5 JETFUEL L <br /> O 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN O 2 WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM D. BELOW) <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 DOUBLE WALL F__] 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN <br /> SYSTEM ® 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTEDTANK) 99 OTHER <br /> 1 BARE STEEL E::] 2 STAINLESS STEEL AP35 <br /> B. TANK ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP <br /> (Primary Tank) ❑ 9 BRONZE 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER <br /> 1 RUBBER LINED ❑ 2 ALKYD LINING 3 EPDXY LINING 4 PHENOLIC LINING <br /> C.INTERIOR 5 GLASS LINING 6 UNLINED ❑ 95 UNKNOWN 99 OTHER <br /> LINING - <br /> IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO— <br /> D.CORROSION ❑ 1 POLYETHYLENE WRAP 2 COATING 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION ❑ 5 CATHODIC PROTECTION 91 NONE 95 UNKNOWN 99 OTHER <br /> E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLEDY(EAJi)UNKNdbt/1.1 OVERFILL PREVENTION EQUIPMENT INSTALLED(YW)UNV t O N <br /> IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A. SYSTEM TYPE A U 1 SUCTION A Q 2 PRESSURE A U 3 GRAVITY A U 99 OTHER <br /> B. CONSTRUCTION AUO1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br /> C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A0 4:FtBERr Fli? <br /> CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING A U 8 lb/ IJIE7(iANOL COMPATIBLE W/FRP <br /> PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER <br /> 3 INTERSTITIAL <br /> D. LEAK DETECTION #.€ MDETECTQR X2 L, 4f$SfESTHV6C-" ❑ MONITORING ❑ 99 OTHER <br /> V.TANK LEAK DETECTION LS ZSC� <br /> ❑ 1 VISUAL CHECK 2 INVENTORY RECONCILIATION D 3 VADOZE MONITORING: 5 GROUND WATER MONITORING <br /> 5<6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING 91 NONE 97;,75 UNKNOWN 99 OTHER <br /> VI.TANK CLOSURE INFORMATION <br /> 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH <br /> SUBSTANCE REMAINING GALLONS INERT MATERIAL? YES E] NO ❑ <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> APPLICANTS NAME DATE <br /> (PRINTED&SIGNATURE) r I <br /> G G. <br /> LOCAL AGENCY USE ONLY THE S ATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW <br /> COUNTY# JURISDICTION# FACILITY# TANK# <br /> STATE LD.# <br /> PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE <br /> FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILE;WFOR0030-115 <br /> do 0 <br />