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STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION-FORM B =ate 1�'aopa+•' COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT a 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ t AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE a 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ARCO AM/PM Facility No. 6347, Tracy, CA I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNERS TANK I.0.0 1 B. MANUFACTURED BY: Xerxes C. DATE INSTALLED(MOAOAYNEAR) C` D. TANK CAPACITY IN GALLONS: 20,000 II.TANK CONTENTS IF A.1 IS MARKED.COMPLETE ITEM G t MOTOR VEHICLE FUEL ❑ t OIL B. G la RFfUV.A UNLEADED S DIESEL 6 AVIATION GAS A ��'{ it)K'REMNM UNLEADED a GASAHOL 7 METHANOL ❑ 2 PETROLEUM ❑ 80 EMPTY AGIi 1 PRODUCT tc MIOGAADE UNLEADED5 JET FUEL M 8 M85 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE 2 LEADED p 99 OTHER(DESCRIBE IN ITEM 0.SELOM D. IF(A.t)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.R Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.L AND C.AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF m t DOUBLE WALL 3 SINGLE WALL WITH EXTERIOR LINER ❑ 5 U MRNAL BLADDER SYSTEM Q 95 UNIQJOWN SYSTEM ❑ 2 SINGLE WALL ❑ t SINGLE WALL W A VAULT ❑ 99 OTHER S. TANK ❑ I BARE STEEL ❑ 2 STAINLESS STEEL 3 FIBERGLASS ❑ a STEEL CLAD WA FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE WAFRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ t RUBBER LINED Q 2 ALKYO LINING ❑ 3 EPDXY LINING ❑ a PHENOLIC LINING LINING OR ❑ 5 GLASS LINING a 6 UNLINED ❑ 95 UNKNOWN ® 99 OTHER FRP COATING IS LINING MATERIAL COMPATIBLE WITH IOC% METHANOL 7 YES NO— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP Q 2 COATING ❑ 3 VINYL WRAP ® a FIBERGLASS REINFORCED PLASTIC CORROSION ❑ 9t NONE ss unKNOWN 99 OTHER PROTECTION ❑ 5 CATHODIC PROTECTION SPILLCONTAINMENT INSTALLED(YEAR) OVERFILL REVELATION EQUIPMENT INSTALLED(YEAR) E SPILL AND OVERFILL,9tC. DROP TUBE VES. -- NO STRIKER PLATE YES� NO DISPENSER CONTAINMENT YES k NO _— IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNOERGROUNO.BOTH IFAPPUCASLE A. SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U a FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U t SINGLE WALL A�2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U t FIBERGLASS PIPE CORROSION A U S ALUMINUM A U 6 CONCRETE A U 7 STEEL W100ATING A U g t00% METHANOL COMPATIBLE WAFRP PROTECTION A U 9 GALVAMZED STEEL A U TO CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 >a6tlwaCAt UNE LEw ®2 UNE TMMTAU ©3 colamlumm wmumaL Cj a EIPC1 ooc UNE ®S allloNAnc PUMPCl 99 oTHEx OEfECTCA TESTING U(lItTOJtII1Q CEN(DETECTOR S�IRC01nN V.TANK LEAK DETECTION ❑ ISITI 2 MANUAL INVENTORY r7UND WATER 6 ANNUAL TANK I VISUAL CHECK 7" RECONCIUATION MONITOR[NG ❑ GAUGING ❑ MONITORING ❑ TESTING ® 7 CONTINUOUS INTERSTITIALQ g SIR Q 8 WEEKLY MANUAL Q 10 MONTHLY TANK a 95 UNKNOWN Q 99 OTHER MONITORING TANK GAUGING TESTING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACF) ,�(1 t.ESTIMATED DATE LAST USED(MWAY/YR) I 2.ESTIMATED QUANTITY OF ! 3.WAS TANK FILLED WITH YES a NO❑ SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 THIS FORM HAS SEEN CoMpWM UNDER p NALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT TANK OWNER'S NAME �_ DAT� �r (F GI NTF.D A SIGNATURE) ��T� LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY R JURISDICTION If FACILITY 21W TANK a STATE I.D.4 = = l0 [70FUIME PERMIT NUMBER PERMIT APPROVED BYADATE PERMIT EXPIRATION DATE MI THIS FORM MU T BE SHOULD BE ACCOMPANIED BY AANIED BY A I PLOT PLAATION-FORM N. FILE THIS FORM WfM T))E LOCAL AUNLESS A CURRENT GENCY PLEMENTImG THE UNDERGROUND STORAGEMA KASVEENFILED. FORM C MUST BE ETANK REGULATIONS THISFORM FORM B (6-95) F"C( 0 1I140bd WdZZ: L L661-60—L