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STATE OF CALIFORNIA Ap ti, STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM 8 10 cl COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT 3 RENEWAL PERMIT -j< 6 CHANGE OF INFORMATION F--] 7 PERMANENTLY CLOSED ON SITE ONE ITEM F--] 2 INTERIM PERMIT a 4 AMENDED PERMIT F-] 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS-- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# A I B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR) \qc� -v D. TANK CAPACITY IN GALLONS: C)o 1 NJ- [LTANK CONTENTS IFA-1 IS MARKED,COMPLETE ITEM C. A. _U1 MOTOR VEHICLE FUEL 4 OIL B. C. ❑ 1"UNLEADED REGULAR 3 DIESEL 6 AVIATION GAS F-] 2 PETROLEUM 80 EMPTY 1 PRODUCT lb=UM 4 GASAHOL 7 METHANOL DED 5 JET FUEL 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 C.A.S. Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF 1 DOUBLE WALL E::] 3 SINGLE WALL WITH EXTERIOR LINER 1--] 95 UNKNOWN SYSTEM Y2 SINGLE WALL � 4 SECONDARY CONTAINMENT (VAULTED TANK) El 99 OTHER B. TANK F-] 1 BARE STEEL F-] 2 STAINLESS STEEL X'3 FIBERGLASS 0 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL F-] 5 CONCRETE F--j 6 POLYVINYL CHLORIDE F-] 7 ALUMINUM F-] 8 1009/6 METHANOL COMPATIBLEW/FRP (Primary Tank) D 9 BRONZE 10 GALVANIZED STEEL [::] 95 UNKNOWN E] 99 OTHER C.INTERIOR F--] 1 RUBBER LINED 2 ALKYD LINING F7 3 EPDXY LINING F-] 4 PHENOLIC LINING LINING F-] 5 GLASS LINING 6 UNLINED F--1 95 UNKNOWN E] 99 OTHER IS LINING MATERIAL COMPATIBdWITH 1009/6 METHANOL? YES NO D.CORROSION F-] 1 POLYETHYLENE WRAP E] 2 COATING 3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION F-1 5 CATHODIC PROTECTION � 91 NONE 95 UNKNOWN 99 OTHER___ E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR)_nq OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR)Lqq IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A72 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL 2 DOUBLE WALL A U 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)A4' FIBERGLASS FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W1COATING A U 8 100r/6 METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER --------N TgWff IA D. LEAK DETECTION L��J9 AUTOMATIC LINE LEAK DETECTOR E�1'2 LINE TIGHTNESS TESTING I P-7-3 -- N L MONITORING [::] 99 OTHER V.TANK LEAK DETECTION [::] 1 VISUAL CHECK L;�f-2 INVENTORY RECONCILIATION F--] 3 VADOZE MONITORING 4 AUTOMATIC TANK GAUGINGF-] 5 GROUNDWATER MONITORING E] 6 TANK TESTING ® 7 INTERSTITIAL MONITORING F-1 91 NONE E 95 UNKNOWN � 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAY/YR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES D NO SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME DATE (PRINTED&SIGNATURE) k4 LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION# FACILITY# TANK# STATE I.D.# FI-I = I I I I I I I I I PERMIT NUMBER PERMIT APPROVED BY/DATE — PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (12-91) 9 FOR00348-R6