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STATE OF CAUFORNA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8a COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEµ MARK ONLY ❑ i NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLY CLO SITE ONE REM ❑ 2 INTERIM PERMIT ❑ A AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE 6 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: k'x '0.C. 1\06 I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNERS TANK I.0.6 \ ER:- =MANUFACTURED BY: 6C. DATE INSTALLED(MO/DAYHEAR) -�1 CAPACITY IN GALLONS: II.TANK CONTENTS IFA-11SMARKED.COMPLETE ITEMC. A. X) 1 MOTOR VEHICLE FUEL ❑ t OIL S. C 1AUNLEADED REGULAR 3 DIESEL ❑ 6 AVIATIONGAS LMJ ❑ 2 PETROLEUM ❑ W EMPTY ® 1 PRpp(JCT ❑ Ib PREMIUM A GASAIgI ❑ 7 METHANOL ❑ 3 CHEMICAL PRODUCT ❑ 95 UNIQHOWN ❑ 2 WASTE 2 UNLEADED a 5 JET FUEL ❑ LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELO" D. IF(AA)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.9: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.S.AND C.AND ALL THAT APPLIES IN BOX D AND A. TYPE OF ❑ I DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ® 2 SINGLE WALL ❑ A SECONDARY CONTAINMENT (VAULTED TANK) ❑ W OTHER B. TANK ❑ I BARE STEEL ❑ 2 STAINLESS STEEL ® 3 FIBERGLASS ❑ A STEEL CLAD Wi FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ S CONCRETE ❑ 6 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 10DI. METHANOL COMPATIBLE WIFRP (Primary TA6k) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ W OTHER ❑ I RUBBER LINED ❑ 2 ALKYD LNIN NG ❑ 3 EPDXY LINING ❑ ♦ PHENOLIC LING C.W ❑ 5 GLASS LINING ® 6 UNLINED LINING NING ❑ 95 UNKNOWN ❑ W OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL 7 YES— NO— D.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ENI A FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHOOK:PROTECTION ❑ 91 NONE ❑95 UNKNOWN ❑ W OTHER E.SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED(YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED(YEAR) IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION AG 2 PRESSURE A U 3 GRAVITY A U W OTHER 8. CONSTRUCTION AQ), SNGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U W OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U A FIBERGLASS PIPE CORROSION A U S ALUMINUM A U 6 CONCRETE A U 7 STEEL"COATING A U 6 100% METHANOL COMPATIBLE WrFRP PROTECTION 1 U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U W OTHER A� 0. LEAK DETECTION ® I AUTOMATK;UNEIEAKDETECTOR ® 2 LINETGNTNESSTESTING ❑ IIDNROPWG ❑W OTHER /9 V.TANK LEAK DETECTION ❑ I VISUAL CHECK ❑ 2 NVENTORY RECONCILIATION ❑ 3 VADOZE MONITORING ❑ A AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 6 TANK TESTING ❑ 7 INTERSTITIALMONRORING ❑ 91 NONE ❑ 95 UNKNOWN ❑ W OTHER VI.TANK CLOSURE INFORMATION 1.ESTIMATED DATE LAS ED(I /AYMR) 2.ESTIMATED QUANTITY OF �LONS 3 WAS TANK FILLED WITH YES ❑ 'L\In SUBSTANCE REMAINING THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME IPRIK Da SK ANM \` DATE LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMB RS BE COUNTY 9 JURISDICTION s FACB. • TANK 9 STATE I.D.# 5 PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE VV THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS BEEN FILED. /) a FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE REGULATIONS '--?U/IP-� FORM 8 (12-91) ROMMI-AF