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4JV•Cw STATE OF CALIFORtaA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION • FORM 8 COMPLETE A SEPARATE FORM�FORZEH TANK SYSTEM MARK ONLY 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMAN 'TLY CLOS— ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE ❑ 8 TANK RE OVED TE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: /!/d 7 (44� o_ I. TANK DESCRIPTION COMPLETE ALL ITEMS— SPECIFY IF UNKNOWN A. OWNER'S TANK 1.0.t 15 B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR) ICA ' D. TANK CAPACITY IN GALLONS: II.TANK NTENTS IFA•IISMARKEO.COMPLETE ITEM 0. A. g 1 MOTOR VEHICLE FUEL 4 OIL 8, C to REGULAR 3 DIESEL UNLEADEDL}�--11 ❑ 6 AVIATICN GAS r72 PETROLEUM ❑ 80 EMPTY 1 PRODUCT ❑ Ib PREMIUM 4 GASA40L ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT C—] 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED UNLEADED ❑ 5 JET FUEL ❑ 0. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED 99 OTHER (DESCRIBE IN ITEM 0. BELOW) 111. TANK CONSTR TION MARK ONE ITEM ONLY IN BOXES A.B.ANO C.AND ALL THAT APPLIES IN BOX 0 A. TYPE OF I DOUBLE WALL 17 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL 4 SECONDARY CONTAINMENT (V LILTED TANK) 99 OTHER B. TANK ❑ 1 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 (Primary Tank) 9 BRONZE ❑ 10 GALVANIZED STEEL 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ALKYO LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ veUNLINEDLINING 5GLASS LINING ❑ 95 UNKNOWN ❑ 99 OTHER IS LINING MATERIAL. COMPATIBLE WITH 100%METHANOL? YES_ NO_ D.CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING El3 VINYL WRAP 4 FIBERGLASS REINFORCED PLASTIC PROTECTION S CATHODIC PROTECTION 91 NONE � 95 UNKNOWN 99 OTHER IV.PIPING INFORMATION CIRCLE A IFABOVE GROUND OR U IFUNCERGAOUNO.BOTH IFAPPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 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 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)Af IJ 14 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING AY 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ❑ I AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING 3 A LAL gg OTHER M0NITOAING V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VAPOR MONITORING 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER ER MCNITCRING ❑ 6 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST USED(MO/DAYNR) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL? YES ❑ NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME (PRMTED A SIGNATURE) PATE LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW Cil/ STATE I.D.; '�" COUNTY x JURISDICTION 0 FACILITY tt TANK 9 MI PERMIT NUMBER PERMIT APPROVED 8Y/OATEPERMIT EXPIRATION DATE FORM 8 (9.90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORO¢1454U