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FORM `F31: U1111- CRGROUND STORAGE TANK P- ')GRAM TANK TAWK PERMIT APPLICATION INFOti'TCIATION N-��' y COMPLETE A SEPARATE FORM WITH THE FOLLOWING INFORMATION FOR EACH TANK. MARK ONLY 1-NEW PERMIT ❑3 RENEWALPERMIT E05 CHANGE OF INFORMATION ❑7 PERMANENTLY CLOSED TANK ONE ITEM ❑ 21NTERIMPERMIT ❑/AMENDEDPERMIT ❑6 TEMPORARY TANK CLOSURE ❑8 TANK REMOVED I FACILITY/SITE NAME WHERE TANK IS INSTALLED: Exxon RAS # 7-333 FARMTANK-YES[ NO ❑X I. TANKDESCRIPTION COMPLETE ALL ITEMS-IF UNKNOWN-SO SPECIFY A. OWNERS TANK ID E I B. MANUFACTURED BY: C. YEAR INSTALLED D. TANK CAPACITY IN GALLONS: 11. TANK CONTENTS IF(At),IS MARKED,COMPLETE ITEM C.IF(A.1),IS NOT MARKED,COMPLETE ITEM D. A ® 1 MOTOR VEHICLE FUEL ❑2 PETROLEUM 8. C. © 1 UNLEADED ❑2 LEADED ❑3 DIESEL ❑3 CHEMICAL PRODUCT ❑ A OIL ® 1 PRODUCT ❑A GASAHOL ❑ 5 JET FUEL ❑6 AVIATION GAS ❑5 HAZARDOUS ❑ 80 EMPTY ❑95 UNKNOWN ❑2 WASTE ❑ 7 METHANOL ❑ 99 OTHER(DESCRIBE IN REM D.BELOW) D. IF NOT MOTOR VEHICLE FUEL.ENTER NAME OF HAZARDOUS SUBSTANCE STORED d C.A.S.F CA S.A: ,III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A.8,C.AD A.TYPE OF ❑ I DOUBLE WALLED ❑3 SINGLE WALLED WITH EXTERM LINER ❑95 UNKNOWN SYSTEM ®1 SINGLE WALLED ❑A SECONOVIY UrtAIWEM ❑99 OTHER L5Y 1 STEEI>'IRON ❑2 STAINLESS STEEL ❑3 FIBERGLASS ❑!STEEL CIAO W/FIBERGLASS REINFORCED PLASTIC B.TANK ❑5 CONCRETE ❑6 POLYWNYLO(LOBDE ❑ /ALUMINUM ❑8100%METHANOLCOMFARBLEFRP MATERIAL ❑9 BRONZE ❑ 10 GALVANIZED SIE11 ❑95 UNKNOWN ❑99 OTHER F-1I RUB6ERUNED ❑2 ALKYO LINING ❑3 EPDXY LINING ❑A MENOLICUNING C. INTERIOR LINING ❑5 GLASS LINING �C 6 UNLINED [j95 UNKNOWN ❑ISUMNG MATERIAL COMPATIBLE WITH 100%METHANOL? ❑YES ❑NO ❑99 OTHER D.CORROSION ❑ I POLYETI9ENE WRAP ❑1 TAR OR ASPRLLT ❑3 VNYL WRAP ❑l FIBERGLASS REINFORCED PLASTIC PROTECTION 5 CATHOOICPIIOTECTDN ❑91 NONE ❑95 UNKNOWN ❑99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUND. U IF UNDERGROUND.BOTH IF APPLICABLE A SYSTEM TYPE A U 1 SUCTION A(g)2 PRESSURE A U 3 GRAVITY A U 99 OTHER B.CONSTRUCTION A U 1 SINGLE WALLED A U 2 DOUBLE WALLED A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER AUQ 1 STEEL+'IRON A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) A U A FIBERGLASS PIPE 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 GALVANIZEDSTEEL A U 95 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 S IVISUAL CHECK OS 2 INVENTORY RECONCILIATION P S 3VADOSE WELLS P S A ELECTRONIC MONITOR P S 5 GROUND WATER MONITOFUNG WELLS P(-S B PRECISION TESTING P S 7 PRESSURE TESTING P S 91 NONE P S 95 UNKNOWN P S 99 OTHER VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1.ESTIMATED DATE LAST USED(MO/YR) 2.ESTIMATEDOUANTITYOF 1 WAS TANK EILLEO WITH SUBSTANCE REMAINING 1 ALLOWS INERT MATERIA1.7 ❑YES ❑NO THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJU A TH ST OF MY KNO WLEOGE IS TRUE AND CORRECT. APPLICANT'S IeE &NM�C fl.E) DAT U.G.T. ANALYST 9i LOCAL AGENCY USE ONLY CO:::::T i JURISDICTION• AGENCY E FACILITY ID• TANK ID F CURRENT LOCAL AGENCY FACILITY ID F APPROVED BY NAME PHONE F WITH AREA CODE 3 PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE CHECK• PERMIT AMOUNT SURCHARGE AIR. FEE CODE RECEIPT F eY: FORM 8 0-788) THIS FORM MUST BE ACCOI '!,ED BY A FACILITY/SITE APPLICATION, FORM 'A',UN A CURRENT FORM'R HAS BEEN FILED �.. DATA PROCESSING COPY ..� h