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4v STATE OF CALIFORNIA <br /> STATE WATER RESOURCES CONTROL BOARD <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 <br /> COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. 4 Sit ol <br /> MARK ONLY 1 NEW PERMIT F7 3 RENEWAL PERMIT 6 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE <br /> ONE ITEM 2 INTERIM PERMIT a 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED <br /> DBA OR FACILITY NAME WHERE TANK IS INSTALLED: <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS.. SPECIFY IF UNKNOWN <br /> A. OWNER'S TANK 1.D.# ( A C. <br /> MANUFACTURED BY: <br /> [L. D=ATEINSTALLED(MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: <br /> ILTANKCONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. <br /> A. -5�1,11 MOTOR VEHICLE FUEL C.4 OIL B. la REGULAR <br /> UNLEADED 3 DIESEL 6 AVIATION GAS <br /> 4 GASAHOL <br /> 2 PETROLEUM 80 EMPTY 1 PRODUCT F-] lbPREMIUM 7 METHANOL <br /> UNLEADED 5 JET FUEL <br /> F-] 3 CHEMICAL PRODUCT a 95 UNKNOWN 2 WASTE O 2 LEADED 99 OTHER (DESCRIBE IN ITEM D. BELOW) <br /> D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. <br /> Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALLTHAT APPLIES IN BOX)AND E <br /> A. TYPE OF F--] 1 DOUBLE WALL F-] 3 SINGLE WALL WITH EXTERIOR LINER El 95 UNKNOWN <br /> SYSTEM 2 SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) F7 99 OTHER <br /> B. TANK 1 BARE STEEL 2 STAINLESS STEEL F--j 3 FIBERGLASS 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC <br /> MATERIAL F-] 5 CONCRETE 6 POLYVINYL CHLORIDE 7 ALUMINUM 8 100% METHANOL COMPATIBLEW/FRP <br /> (Primary Tank) 9 BRONZE 10 GALVANIZED STEEL 95 UNKNOWN 99 OTHER <br /> C.INTERIOR 1 RUBBER LINED F-� 2 ALKYD LINING F-] 3 EPDXY LINING 4 PHENOLIC LINING <br /> LINING F-] 5 GLASS LINING -5;<06 UNLINED El 95 UNKNOWN 99 OTHER <br /> IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO <br /> D.CORROSION [::] 1 POLYETHYLENE WRAP F--] 2 COATING � 3 VINYL WRAP F--j 4 FIBERGLASS REINFORCED PLASTIC <br /> PROTECTION � 5 CATHODIC PROTECTION->�f 91 NONE F]95 UNKNOWN F-] 99 OTHER <br /> E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) <br /> IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE <br /> A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY ;Ogg OTHER <br /> B. CONSTRUCTION A 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br /> C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE <br /> CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW(COATING A U 8 100% METHANOL COMPATIBLEW/FRP <br /> PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN AM 99 OTHER <br /> D. LEAK DETECTION D 1 AUTOMATIC LINE LEAK DETECTOR E:] 2 LINE TIGHTNESS TESTING IRSTI I IlL <br /> L MONITORING <br /> gg OTHER J <br /> V.TANK LEAK DETECTION <br /> [ <br /> Ej 1 VISUAL CHECK 2 INVENTORY RECONCILIATION F-] 3 VADOZE MONITORING = 4 AUTOMATIC TANK GAUGING 5 GROUND WATER MONITORING <br /> ;=�<6 TANK TESTING 7 INTERSTITIAL MONITORING F 91 NONE (ML95 UNKNOWN 99 OTHER <br /> VI.TANK CLOSURE INFORMATION <br /> L ESTIMATED DATE LAST USED(MO/DAY/YR)R) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES N <br /> t5 <br /> --25- ' SUBSTANCE REMAINING lw-k— GALLONS INERT MATERIAL? <br /> O*< <br /> 9 - <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT <br /> APPLICANTS NAME DATE <br /> (PRINTED&SIGNATUREI <br /> LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW <br /> STATE I.D.# COUNTY# JURISDICTION# FACILITY# TANK# <br /> F-FI-1 b lo I El I 1 11 1 1 <br /> PERMIT NUMBER PERMIT APPROVED BY/DATE Ll PERMIT EXPIRATION DATE <br /> THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. <br /> FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS <br /> FORM B (12-91) <br /> FOR00348-R6 <br />