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o, <br /> STATE OF CAUFOWiA <br /> STATE WATER RESOURCES CONTROL BOARD <br /> UNDERGROUND STORAGE TANK PERMIT APPUCATION-FORM 8 <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. <br /> 7 PERMANENTLY <br /> 0.CSED ONSITE <br /> 1 <br /> RENEWAL PERMIT '� 5 CH +E CF INFORMATION �� d TANK REMOVED <br /> iii <br /> t <br /> NEW asauli g TEMPORARY TANK CLOSURE <br /> _ <br /> 2 INTERIM PERMIT 6 AMENDED PERMIT <br /> ITY NAME WHERE TANK IS INSTALLED: <br /> ::: <br /> CRIPTION COMPIETEAL/LITEMS-- SPECIFYIFUNKNOWx MANUFACNPEDBV: �/. K <br /> TANK 1.0.a 'L �1' L ` 0. TANK CAPACITY INALLED(MOIOAYWEARI <br /> II.TANK CONTENTS IFA-1ISMAR TED.COMPLErITEMC ,AREGULAR 7 DIESEL u 8 AVATONGAS <br /> G I UNLEADED A GASANCL <br /> MOTOR VEHICLE FUEL n OIL I 8. 'I I� 7 MtT.HAxDI• <br /> A. EtdPly t PRODUCT m PREMIUM I� 5 JET•FUEL <br /> �I 2 PETROLEUM IJ — UNLEADED <br /> �^-'T % UNIo'IOWN I ^ 2 WASTE I� 2 I.EAOED H OTHER ;DESCRIBE IN ITEM 0. BELCwI <br /> o CHEMICAL PRODUCT <br /> ❑. IF(A.11 IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED q�• L> .IG <br /> III. TANK CONSTRUCTION MARK ONE REM ONLY IN BOXES A B ANGC.AND ALLTNATAPPUES IN 9OKO_ Z T <br /> DOUBLE 'MALL <br /> SINGLE WALL WITH EXrAIOR LINER % UNKNOEWII�BERGIASS <br /> A. TYPE OF A SINGLE WALL <br /> CONTAINMENT AULTED TANIQ I� 9B OTHER <br /> SYSTEM � 2 SINGLE WALL r A STEL CREINFORCED PLASTIC <br /> 7 2 STAINLESS ST-''1 IJ 9 %TBERGLhSS '_fj 1 3ARE STEEL T ALUMINUM J d t00% MPATIBLE WIFRP <br /> B. TANK --7 S CONCRETE ❑ 8 POLYVINYL CHLORIDE — <br /> MATERIAL to GALVANIZED STEEL % UNIo/0wx I� OTHER <br /> ;Primary Tank) 9 BRONZE IC LINING <br /> — <br /> t RUBBER LINED 11 ALKYL LW Wo �K•y LINING A PHENOL <br /> G 1. J <br /> C.INTERIOR — UNLINED % UNKNOWNI� 90 OTHER <br /> 'i 5 GL.A35 LINING = <br /> LINING — <br /> :S LINING MATERIAL COMPATIBLE YAT11 100% METHANOL' YES— NO- <br /> 3 <br /> — <br /> WY <br /> _ ] VL WRAP ;� s FIBERGLASS REWFORCCO PLASTIC <br /> I POLYETHYLENE'WRAP 2 COATING a n OTHER <br /> 0.CORROSION — ,% UNKNOWN <br /> PROTECTION ^' g CATHODIC PROTECTKW IJ 91 NONE — <br /> IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND <br /> RESSURE�E� GPnYAPP�IMAeLE A D 90 OTHER <br /> A. SYSTEM TYPE A U i SUCTION ^C.:! <br /> A U 2 DOl18LE WALL <br /> A®1 LIMED THI ILH A U % UNKNOWN A U 38 OTHER <br /> 3. CONSTRUCTION A U 1 SINGLE WALL a =IBERGLASS PIPE <br /> A U f BASE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A® <br /> C- MATERIAL AND A U 8 CONCRETE A U 7 STEL WICOATING A U a t00% METHANOL COMPATIBLE WIFRP <br /> CORROSION <br /> Ig10 CATHOOICP TECTK)N A U 96 UNKNOWN A U OTHER92 <br /> 07HER <br /> PROTECTION A U 9 GALVAND STEEL A U <br /> I AUTOMATIC U — <br /> NE LEAK DETECTOR 2 UNE TIGHTNESS TESTING i_; T Iy� oim J <br /> gp <br /> 0. LEAK DETECTION ❑ <br /> V.TANK LEAK DETECTION ^T s GAouNo wATR MONITORING <br /> �ISUAL CHECK 2 INVENTORY RECONCNATION 3 VAPOR NONITORIIGI� gg AUUNKNOAAMTA"K ' 'L-J go �R <br /> (� 7 INTERSTITIAL MONITORING J 91 ,NNE irJ1 <br /> g TANK TESTING IJ <br /> VI.TANK CLOSURE INFORMATION i 2 ESTIMATED QUANTITY OF 1 WAS TANK FILLED WITH ,� I No❑ <br /> ESTIMATED DATE LAST USED(MUIUAY/YR) GALLONSI (NEAT NATERUL7 <br /> SUBSTANCE REMAINING <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF UY KNOWLEDGE IS TRUE AND CORRECT <br /> DATE <br /> APPLICANTS NAME <br /> IPgNTEDagIGNATUPO <br /> LOCAL AGENCY USE ONLY THE STATE LD.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW TANK AlCOUNTY it JURISDICTIONS FACILftY 71 ,I_e..s5& <br /> STATE I.D. � I if><^�� <br /> PERMIT NUMBER PERMIT APPROVED BYNATE <br /> "I PERMIT EVIRATION DATE <br /> RRENT FORMA HAS BEEN FILED- <br /> THIS FORM MUST BMP <br /> E ACCOMPANIED BY A PERMIT APPLICATION-FORM A.UNLESS A CU <br /> :CRN a 19-901 <br />