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s- _ 'i STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD ;y UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM 8 COMPLETc A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ❑ i NEW PERMIT ❑ 3 RENIhEWAL PERMIT ❑ 5 CHANGE OF INFORMATION ❑ PERMANENTLY CLOSED ON SITE ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECKFf IF UNKNOWN A. OWNER'S TANK I.D.R �O S. MANUFACTURED BY: .u C. DATE INSTALLED(MOIDAWYEAR) ' 2_ D. TANK CAPACITY IN GALLONS: Lo on O II.TANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C- A. 1 MOTOR VEHICLE FUEL ❑ 4 OIL & � C. Ea REGULAR UNLEADED ❑ 3 DIESEL ❑ 6 AVIATION GAS F72 PETROLEUM C] BO EMPTY ij S PRODUCT ❑ 1b PREMIUM UNLEADED E::] 4 GASAHOL ❑ 7 METHANOL ❑ 1c MIDGRADE UNLEADED ❑ 5 JET FUEL ❑ 8 M85 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN,o ❑ 2 WASTE ❑ 2 (FADED ❑ 99 OTHER(DESCRIBE IN ITEM D.BELOW) D. IF(AL1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORM . C.A S.it; III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B,AND C.AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF �❑�{�_ DOUBLE WALL ❑ 3 SINGLE.WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM El 95 UNKNOWN SYSTEM ,(-✓,J{Y SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK L"J I BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (PrimaryTank) ❑ 9 BRONZE ❑ 1D GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER C.INTERIOR ❑ 1 RUBBER LINED ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING . LINING OR ❑ 5 GLASS LINING �el UNLINED ❑ 95 J/NKNOWN ❑ 99 OTHER II COATING IS LINING MATERIAL COMPATIBLE WITH IOD'.:'METHANOL 7 YES j NO— { I D.EMRIOR ❑ I POLYETHYLENE WRAP ❑ 2 COATING ��ll VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE' UNKNOWN ❑ 99 OTHER E SPELL AND OVERFILL,K'[C SPILL CONTAINMENT STALLED(YEAR) .- OVERF(LIIPLE REVENTION EOUIPMENT INSTALLED(YEAR) DROP TUBE YES NO ST R PLATE YES Y NO DISPENSER CONTAINMENT YES NO L IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION A U PRESSURE. A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION U SINGLE WALL A U 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 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STE W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U GALVANIZED STEEL A U 10 i�CATHODIC PROTECTION U 5 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 mcToA 1L t LEAK z rEs Trirll�sl ❑3 vrTe!>sTIIIat ❑<� . ED' ❑5� PLW 1:199 OTHER aE1EtTCII TiSI1IG MONlIDPOOG V.TANK LEAK DETECTION ❑ I VISUAL CHECK ❑ MANUAL ONCILIAT�kD�IY '❑.3 MONITORING ❑ 4 GAUGtENG AUTOMATIC TANK ❑5 M MONUND ITORING 6 TE�ANNUG7ANK ❑ 7 CON INUOJG INTERSTITIAL 8 SIR ,❑CIA9 TANK GAUGING ❑10 MONTHLY TANK ❑ 95 UNKNOWN ❑ 99.OTHER TING VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACQ I.ESTIMA O DATE USEb(MO/DAY/YR) 2-E-nmATED OUANTI'TY OF 3.WAS TANK FILLED WITH YES ❑ NO SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 1 a THfS FORM HAS BEEN compLETEDuNDERPENALTY�QFF)qijUgOrAD TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT TANK OWNERS NAME I DA [PRTITM 8 SIGNATURE} NA y v I- j' i _ t T'�r� LJ`f, Vk LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER f MPOSED O E FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE 1.D:4 El J 1 11 PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A.UNLESS A CURRENT TORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS.THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN LE THLS FORM[WRH THE LOCAL AGENCY IMPLEMENTING THE U GROUND STORAGE TANK REGULATIONS FORM B (6-951 ,fit.