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STATE OFCALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - F w ORM 8 COMPLETE A SEPARATE FORM FOR E TANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY❑ ONE ITEM F—] 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED CLOSED ON 517E DBA OR FACILITY NAME WHERE TANK IS INSTALLED: Q Lt 1. TANK DESCRIPTION COMPLETE ALL ITEMS— SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# B. MANUFACTURED BY: C. DATE INSTALLED{MOlDAYfl EAR) D. TANK CAPACITY IN GALLONS: II.TANK CONLMS IFA-1 IS MARKED,COMPLETE ITEM C. A. LI1 MOTOR VEHICLE FUEL ❑ 4 OIL B C I— 1a REGULAR 3 DIESEL �J UNLEADED ❑ 6 AVIATION GAS ❑ 2 PETROLEUM ❑ 80 EMPTY PRODUCT ❑' ib PREMIUM ❑ 4 GASAHOL r UNLEADED ❑ 5 JETFUEL ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF(A 1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED 111. TANK CONSTRUCTION MARK ONNIONLY IN BOXES A,B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF u 1 DOUBLE WALL3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL4 SECONDARY CONTAINMENT {VAULTED TANK) 99 OTHER B. TANK ❑ 1 BARE STEEL ❑ 2 AINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL C=FIBLRGREINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 PO VINYL CHLORIDE ❑ 7 ALUMINUM 8 100% ME WI (Primary Tank) ❑ 9 BRONZE ❑ 10 GAL NIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ C.INTERIOR � LINING 1 RUBBER LINED ❑ 2 ALKYD L ING ❑ 3 EPDXY LI4 PHENOLIC LINING ❑ LINING ❑ 5 GLASS LINING ❑ 6 UNLINED N ❑ 95 UNKNOWN ❑ 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METH ANICL? YES, NO_ D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATONG ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE , ❑ 95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IFUNDERG UND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTfON A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A 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)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WI PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TES ING ❑ 3 N S 1 IAL — MONRORING ❑ 99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ AUTOMATIC TANK GAUGING ❑ 5 GROUNDWATER MONITORING ❑ 6 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 9 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1-ESTIMATED DATE LAST USED(MO/DAY(YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALL S INERT MATERIAL 7 YES ❑ NO f❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST F MY KNOWLEDGE 1S TRUE AND CORRECT RPPLIGANTS NAME (PRINTED 8 SIGNATl1RE1 DATE LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW c , C STATE I.D.# COUNTY# JURISDICTION# FACILITY# TANK# ❑-T-� PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEFV FILED, �.�,"�� FORD B•RS