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SPATE OF CALIFORNIA � '6Wu"CG= STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 w�� COUPLE-=A SEPARATE FORM FOR EAVTANK SYSTEM. MARK ONLY ❑ 1 NEW PERMIT ❑ 3 AFNEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERM ENTLY ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMe4CEO PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK REMOVED OBA OR FACILITY NAME WHERE TANK IS INSTALLED: h,J + ` I. TANK DESCRIPTION COMPLETE ALL ITEMS—3PS.r—Y'FUNKNOWN A. OWNER'S TANK 1.0.s 8. MANUFACTURED BY: lVV/ C. DATE INSTALLED(MC10AY/YEAR) 0. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IFA-1 IS MARKED.CO _-- A. ❑ 1 MOTOR VEHICLE FUEL a OIL B, ❑ to REGUUNLELAR n 3 DIESEL ❑ 6 AVIAN� ❑ 2 PETROLEUM ❑ 80 3NP- ROOUCT ❑ Ib PREMIUM l�_1} 4 �'A4ANOL ❑ 7 METHANOL UNLEADED E V JET FUEL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNK-cm /2WASTE ❑ 2 LEADED 99 OTHER (DESCRIBE IN ITEM 0.3E'CW) 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE S:ZR0 C.A.S.s III. TANK CONSTRUCTION MARK ONE ITEM ONLYlr 30xES A.B.AND C.AND ALL THAT APPLIES IN BOX D A- TYPE OF eK 000BL—E WALL ❑ 3 SI NGLE WALL WITH EXTERIOR LINER El UN WN SYSTEM SINGLE WALL ❑ a SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OT.E uu B. TANK LE/I BARE STEEL 7, Z a.AOCESS STEEL f73 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASSRENFORCM PLASM MATERIAL ❑ 5 CONCRETE 7. 5 -XYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 8 100% METHANOL COMPATIBLE W/FRP (Primary Tanis) ❑ 9 BRONZE L I = 3ALVANIZED STEEL ❑ 95 UNKNO ❑ 99 OTHER ❑ 1 RUBBER LINED �❑ 2 AL'(YO LTIWG ❑ 3,6Y LINING ❑ a PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING ❑ S iT NED 9S UNKNOWN ❑ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITI4 =%METHANOL? YES_ 0.CORROSION ❑ ' POLYETHYLENE WRAP ❑ 2 COATINGj9/5 3 WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHOOIC PROTECTION(i 31 NONE UNKNOWN ❑ W OTHER PIPING INFORMATION CIRCLE A IFABOVEWCLT40OR U IFUNOEAGROUNO.BOTH IFAPPLICABLE $C. SYSTEM TYPE A U 1 SUCTION A 7 2 PRESSURE A U 3 GRAVITY A U 99 OTHER CONSTRUCTION A U 1 SINGLE WALL A 7 2 DOUBLE WALL A U 3 LNED TRENCH A U 95 UNKNOWN A U 99 OTHER MATERIAL AND A U 1 BARE STEEL A 7 2 STAINLESS STEEL A U 3 POLYVINYL CHLORICE(PVC)A U 4 MaERGLASS PIPE CORROSION A U 5 ALUMINUM A 7 6 CONCRETE A U 7 STEEL W/COATING A U 8 100%METHANOL COMPATBLW/FRP PROTECTION A U 9 GALVANIZED STEEL A 7 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER . LEAK DETECTION ❑ I AUTOMATIC LINE LEAK 00- .DR ❑ z LINE TIGHTNEss TEsnNG ❑ 3 vcNITORING ❑ OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECCMX'A 1CN ❑ 3 VAPOR MONITORING❑ 4 AUTOMATIC TANK GAUGING❑ 5 GROUND WATER MONITORING \jV �❑ a TANK TESTING ❑ 7 INTERSTTTIALMONRORINC ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION I.ESTIMATED DATE LAST USED(MOIOAYNR) Z.ESTIMATED CUANTRY OF 1 WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS1 INERT MATERIAL 7 YES ❑ !!0 Cl THIS FORM HAS BEEN COMPLETED UNDER PEIALTY OF PERJURY,AND TO THE BEST OF MY KNOWLtDGE, IS TRUE AND CORRECT APPLICANTS NAME OATS J� laan>EO a slcnwrur+et y V i LOCAL AGENCY USE ONLY THE STATE LD.NWER IS COMPOSED OF THE FOUR NUMBERS BELOW COUN i'y t XRISOICTIqpI x FACILITY I TANK x STATE LD.n IU PERMIT NUMBER _ IT APPROVED /DATE I PERMIT EXPIRATION DATE FORM B (9.901 THIS FORM MUST BE ACCOMPANIED:7 A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED.