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Si ATE OF CALIFORNIA ' STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION -FORM 8 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTE.M. EMARK;[TEM Y I NEW PERMIT CI 3 RENEWAL PERMIT 21 5 CHANGE OF INFORMATION C 7 PFAMANENTLY CLOSED ON SI 2 INTERIM PERMIT4 AMENDED PERMIT fi TEMPORARY TANK CLOSURE 8 TAN17 CILITY NAME WHERE TANK IS INSTALLED: 1. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN ! -' ,T 1 B. MANUFACTURED BY: 1 Q� � y �[�'��^n A. OWNER'S TANK 1.D.N I G� 1.7` � ( l •y 1 I D. TANK.CAPACITY IN GALLONS: 0 C. GATE INSTALLED{MCNDAY/YEAA) C Il.TANK CONTENTS IF A-:IS MARKED.COI ITEM C. to AEv"ULAR UNLrACE7 � 3 DIESEL �� 6 AVIATION GAS A I MOTOR VEHICLE1-7 FUEL 4 OIL B• G td PIIEMAIN UN—EAZED 4 GASAHOL 7 METHANOL �! 2 PETROLEUM E,Ap�D 8O EMPTY I PRODUCT to MOGWE UNL5 1ET FUEL {� B MBS 3 CHEMICALPRCOUCT 95 UNKNOWN 2 WASTE 2 LF-ACED 99 OTHER(CESCRIBENITEMO.3F-OW) 0. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.P: Ill. TANK CONSTRUC11ON MARK ONE ITEM ONLY IN BCXES A.B.AND C,AND ALL THAT APPLIES IN BOX 0 AND E i DOUBLE WALL u 3 SINGLE WALL WITH EXTERIOR LINER � 5 INTERNAL BLADDER SYSTEM � 95 UNKNOWN A. TYPE OF I� 99 OTHER SYSTEM 2 SINGLE "HALL ❑ 4 SINGS-r-WALL IN A VAULT 7 t BSE STEEL [-1 2 STAINLESS STEEL r', 3 Fr9ERGLASS 1 A S�=CLAD .vl FIBERGLASS AEINFORCEO PLASTIC B. TANK 5�J a 1C0: METHANOL COMPATIBLE W1FRP MATERIAL C 5 CONCRETE 77 6 POLYVINYL CHLCRIOE � 7 ALUMINUM E i (Primary Tank) 9 3RONZE IU GALVANIZED S--- - 99 OTHER C 1 RUBBER PINED 2 ALKYD LINING E 3 EPDXY LINING El PHENOLIC LINING C.INTERIOR 95 UNKNOWN 1 lI 99 OTHER LINING CR � 5 GLASS LINING � 6 UNLINED El COATING IS LINING MATERIAL.COMPATIBLE WITH 100% MIE77HANOL? YES— NO� D.EXTERIORI POLYETHYLENE WRAP 17 2 COATING 3 VINYL WRAP I 4 FIBERGLASS REINFORCED PLASTIC CORROSION CK�'1 91 NCNE 95 UNKNOWN 1-. 7 99 OTHER PROTECTION L_J 5 CATHODIC PROTECSION n S?ILL CONTAINMENT INSi ALLEQ(YEARI _ OVERFi L PREVENTION ECULPM. E'NT 1NSTALLE,E(YEAR1 1 ' • E.SPILL AND OVERFILL,etc. CROP TU8E YES� NO STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND.90TH IF APPLICABLE A. SYSTEM TYPE A U t SUCTION A 2 PRESSURE A U 3 GRAVITY A U a -FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 COUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U t BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL Ck41 ORIOE(PVC}A U 3 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 5 CONCRETE A U 7 STEF3WICOATING A U B tOTH METHANOL COMPATIBI�WfFRP PROTECTION A U 9 GALVANIZED STEL A U 10 CATHCOLC PROTECTION A U 95 UNKNOWN A 199 OTHER �y t uEa++u-cay.Lwe 2 LJNE iIGtIT1JESS 171 3 COHItHl10U5 wrg=nAL I a d£CTFG4iC:INE 15 AurouAnc PUS 99 onlES D. LEAK DETECTION (!Jcrca --I tEsrvtG OnJ aar4raa�; L-- FSK oEt=c"ca snrtoowr� V.TANK LEAK DETECTION C t VISUAL CHECK I� 2 MANUALRECONCINVENTORY 3 TION MONITORING 91"4 GAUL NG C TANK �5 MON TARING WATERGROUND E 6 TES'TTNGANNUALTANK 7 MONITORING OUINTERSTITIAL B SIR L� 7 K GAU NGAL to- TESlZNCY TANK L 45 UNKNOWN a 99 OTHER VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) I.ESTIMATED DATE LAST USED{MClDAYMR) Z ESTIMATED QUANTITY OF 3 WAS TANK FILLED WITH 7YESNO 0 SUBSTANCE REMAINING GALLONS INERT MATERIAL 7 THIS FORM HAS BEEN COMPL.°"1 0 UNDER PENALTY OF PERJURY,ANO TO THE BEST OF MY ffNOWLEDGE, IS TRUE AND CORRECT TANK OWNER'S NAMEI :? (�!eY!In0 rAT�E5��- (PFINTEO B SIGNATUAM 1, LOCAL AGENCY USE ONLY THE STATE I.D.NIJ L8 IS admposEoOF THE FOUR NUMBERS 8E'_OW { I Lf COUNTY k JURISOICTION# FACIUTY x TANK A,Gni f L STATE I.D.4 l G I`' IIg1H ?ERMIT NUMBER ` PERMIT APPROVED BYIOATE �PSAMITEXPIRATION DATETHIS FORM MUST BE ACCOMPANIED BY A PERMIT APP N-FORM A•UNLESS A CURRENT FORM A HAS BEEN F[LEH " aOINO STORAG`cST BE FTANK REGULATIONS FOR IN N�THIS FORM SHOULD BE ACCOMPANIED BY A PLOT ILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE ECRM 6 (6.95)