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STATE OF CAL!WMA <br /> 'TATE'HATER RFSOURC`S CCNTROL BOARD A <br /> • <br /> UNDER GROUNe-6T0RAGE TANK PERMIT APPLICATIONwFORM 8 <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. °'�•�- <br /> MARK ONLY ❑ t NEW P£RA1IT ❑ ] REVEwAL P£s76tIT S CHANGE OF INFORMATION ❑ 7 AMANF_NTL/ C L _� S <br /> ONE TEM F72 NTERIAi P$aMIT ❑ 4 AIMENCED PERMIT C] 6 TEMPORARY TANK Ct.OSURE 8 TANK R£MCYED <br /> OBA OR FACI M NAME WHERE TANK LS INSTALLED: <br /> L TANK DESCRIPTION ccamOU- a it�FTEMs- sPsc:xY x uNxNOWN <br /> A.OWNEr1'S TANK L 0.s '�' f I L MANUFACTURED By.- <br /> C. <br /> Y:C:. OA-c 1USTALLE0(T.IC/OAYJYEAA v I CL TANK WAC;TY IN GALL NS,• / <br /> It.TANK Cggf&TS IF A-%IS uARXED.COMPtETE nVA C. / <br /> l t MOTOA VEHICXE FU£L ❑ 4 OIL g, UNLEACtoaED ] OI£S ❑ 6 AYUT7CNCaS <br /> ❑ 2 PETROLE U.I ❑ 90 E4PTY �I PROOUCT ❑ SD PREM4J14 A �L a <br /> X7 METHANOL <br /> UNLEACED S T FUEL <br /> C3 ] t IEMICA(PRC�LCT C-195 UNfCVOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE W ITEM 0. BELayl) <br /> 0. IF(Ail Is uoT tuRKFO. ENTER NAuE OF SUBSTANCE STORED C.A.S.!: <br /> 111. TANK CONSTRUCTION MARK ONE ITEM ONLY NBOXES A.3.ANDC.ANOALLNATAPPUESINBOX0 <br /> A. TYPE OF ❑ DOUBLE WALL ❑ ] SNGLE WALL WIN ExTERICA LN£R ❑ 95 UNKNOWN <br /> SYSTEM SPIGLE WALL ❑ A SECONDARY CCNTANMENT (VAULTED TAMC ❑ 99 OTHER <br /> ❑ I 3ARE STEEL ❑ 2 STANLE$g STEEL ❑ ] Fi8£RGLLSS ❑ 4 STEEL CLtO Wl FIBF;;a.ASo aEINFCRcco PLASTIC <br /> B. TAtlK <br /> MATERIAL ❑ s CONCRETE ❑ 6 POLYVINYL.CHLOAtCE ❑ 7 VMNUM ❑ 6 tOOY. ME;r1ANOL C3MPATSBL=WlFRP <br /> (Primsry Tann) ❑ 9 BRONZE ❑ IO GALVANIZED STEEL 95 VMGVOWN ❑ 99 OTNER <br /> F1 I RU88£R LNSO C] 2 ALKYD UNING &1:5- <br /> t:NGD <br /> XYLNING C] 4 PWENCL1C LNNG <br /> C.INTELINNGR F-15GLASS LINING CD6 UNLW40WN ❑ 99 DINER <br /> IS LNING MATERIAL COMPATIBLE W[N 100% METHANOL? Yes— NO_ <br /> 0.CCRRCSICN ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ ] VIPM WRAP ❑ 4 F13SAGLLSS RENFORCEO PLASTIC <br /> PROTECTION Q S cATFioc c PROTECTION ❑ 91 NONE ❑ 95 UNKNOWN a 99 OTHER <br /> IV.PIPING INFORMATION CIRCLE A IF ABOVE GR UNOOR U IF'UNCEaGROuNo.3aTTdIFAPWcAgLE <br /> A. SYSTEM TYPE A U I SUCTK:44 A U 2 PRESSURE A U ] GAAVRY <br /> A U 99 OTHER <br /> S. CONSTRUCTION A U I SwGLE WALL A U 2 OCUSLE WALL A U ] LINED TRENCH A U 95 UNKjcwN A U 99 OTHER <br /> C. MATERIAL AND A U I BARE STZEL A U 2 STAINLESS STEEL A U ] PCLYVWYL. CHLORIDE(PVC)A U A FIBERGLASS PIPs <br /> CORROSION A U s ALUMINUM A U 6 CC4CPZM A U 7 STEEL WI COATING <br /> A U 9 ,001: METHANOL gMPATIBLEWIFRP <br /> PROTECi10N A U 9 GALVANIZED STEEL A U TO CATHCOICPROTECTICN <br /> A U 95 UNKNOWN A U 99 OTHER <br /> 0. LEAK OETECTION ❑ I AUTCMAT.0 LNE LEAK Oe-,.CTCR Q 2 LINE TZwTNF.SS TE3 T NG ❑ 3:v <br /> a C:] 99 OTH£R <br /> VCNITORW <br /> V.TANK LEAK DETECTION <br /> t vISUAL CHECK ❑ 2 INVENTORY REccNmtAT;cN ❑ 3 VAPaR MaNITaRNo❑ 4 AUTOMATIC TANK GAUGING❑ 5 GRCUNO WAocil uCNITCRING <br /> J ❑ 6 TANK TESTING Q 7 XTEASTMAL MOMMAM ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER <br /> k <br /> VI.TANK CLOSURE INFORMATION <br /> t.ES TLUATE0 OATS LAST USED(MOtOAY/YR) L ESTTMA T EO CUANTITY OF ] WAg TANYC FRiEO WtT>{ YEs C] ❑ <br /> SUBSTANCE REMANNO GALLONS NEAr MATERIAL 7 <br /> THIS FORM HAS BEEN COMFLE7 rB UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT <br /> APPLICANTS NAME <br /> IPftMM A SXINATUM <br /> LOCAL AGENCY USE ONLY THE STATE LD.NUMB E.3 IS COMPOSED OF THE FOUR NUMBERS BELOW <br /> 0 COUNTY S JURISOICTICN s FACiLfTY x TAMC x j <br /> STATE ® [A I I I ol 40 f 11a a <br /> PERMIT NUMBER + PEAMIT APPROVED 8Y/CATe PE7MIT c nON OAT E / <br /> FORM 9 (9.901 THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCA110N-FORM A,UNLESS A CURRENT FORh�7r-HdS3E=3E F <br /> I <br /> Paaoau6.0 <br />