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STATEOFCAUFORMA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM 8 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. RK ONLY 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLY CLO SITE ONE ITEM 2 INTERIM PERMIT ♦ AMENDED PERMIT ❑ 9 TEMPORARY TANK CLOSURE 9 TANK REMOVED NTLY DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS— SPECIFY IF UNKNOWN A. OWNERS TANK I.0.A B. MANUFACTURED BY: C. DATE INSTALLED(MOIDAYIYEAR) 1 0. TANK CAPACITY IB GALLONS: A II.TANK CONTENTS IFA-1 IS MARKED.COMPLETE ITEM C. A. X 1 MOTOR VEHICLE FUEL ❑ A OIL B. G ❑ la REGULAR 3 DIESEL ❑ A AVIATION GAS ❑ 2 PETROLEUM ❑ DED 80 EMPTY ® 1 PRODUCT '1��yI IO PREMIUM A GASAHOL 7 METHANOL ❑ 7 CHEMICAL PRODUCT UNLEADED TI�'�� 5 JET FUEL ❑ ❑ 9S UNKNOWN ❑ 2 WASTE ❑ 2 LEADED U 99 p711ER (DESCRIBE IN ITEM 0. BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. : III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.9,AND C.AND ALL THAT APPLES IN BOX D AND A TYPE OF ❑ I DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM Rl 2 SINGLE WALL ❑ A SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER B. TANK ® 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ A STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 9 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 1001E METHANOL COMPATIBLE W/FRP (P6mwyTmk) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 00 OTHER ❑ I RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ A PHENOLIC LINING C.INTERIOR ❑ 5 GLASS LINING ® 9 UNLINED ❑ 95 UNKNOWN ❑ W OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL 7 YES_ NO D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ A FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHOOICPROTECTION ❑ 91 NONE 95 UNKNOWN ❑ 99 OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNOOR U IF UNDERGROUND.BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION AQ)2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION AU1 SINGLE WALL A U 2 OQUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U N OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A Gl FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 9 CONCRETE A U 7 STEEL W1 COATING A U B IO METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODICPROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR �2 LINE TIOHTNESS TESTING Q MW 'TOKRORMG ❑ 99 OTHER V.TANK LEAK DETECTION ❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ a AUTOMATIC TANK GANGING ❑ 5 GROUND WATER MONITORING PC9 TANK TESTING ❑ 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAST US QQ Y R) 2.ESTIMATED QUANTITY OF 3.WAS TANK FILLED WITH YES ❑ NO SUBSTANCE REMAINING J' GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME )\ DATE IPNNTFJIA 91GKATuw T��\J C L� LOCAL AGENCY USE ONLY THE STATE LD.NUMBER IS OMPOSED OF THE FOU NUMB S BELOW STATE I.D.# COUNTY N JURISDICTION• ITY Y TANK• QQ PERMIT '� S NUMBER PERMIT APPROVED BY/OATE PERMIT EXPIRATION DATE I b D THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. FORM B (1291) FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAjWANK REGULATIONS � W �i