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STATE OF CALIFORNIA j•,_.,,'c STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 COMPLEt E A SEPARATE FORM FOR;A/C .4 TANK SYSTEM. MARK ONLY ❑ I NEW PERMIT ❑ ] RENEWAL PERMIT S CHANGE OF: INFORMATION \❑ 7 PERMAN SITE ONE REM 2 INTERIM PERMIT ❑ A AMENDED PERMIT ❑ S TEMPORARY TANK CLOSURE ILII A TANK .aE VE OSA OR FACILITY NAME WHERE TANK IS INSTALLED: gco I I I. TANK DESCRIPTION CCMP_5TE ALL ITEMS- SPECIFY IF UNKNOWN A. OWNER'S TANK 1.0., n I B. MANUFAC:UPED BY: C. DATE !INSTALLED IMWAYIYEAR) I 0. TANK CAPACITY IN GALLONS: 1yI II �N It.TANK CONTENTS FA-IISMARKEO.COMPETEREMC. A. MOTOR VEHICLE FUEL ❑ t O0. 8. / ❑C. 13UREGULAA NLEACEO �/ ] DIESEL ❑ 8 AVIATION OAS \�'p 2 PETROLEUM ❑ 50 EMPTY I PRODUCT I ❑ 10 PREMIUM a GAS ❑ V ❑ UNLEADED S ZTFUEL 7 METHANOL] CHEMICAL PROCI:CT ❑ 95 UNKNOWN ❑ 2 'HASTE ❑ 2 LEADED 9I OTHER (DESCRIBE .N (TEY 0. BELOW)D. IF(A.I)IS.NOTMARKEO. ENTER NAME CFSUSSTANCE STORED III. TANK CONSTRUCTION MARK ONE REM ONLYN BOXES A.B,ANOC.ANO ALL TNATAPP.IES IN BOX A. TYPE OF ❑ 1 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 ❑ ] FIBERGLASS ❑ a STEEL CU0 'N7 fIBEAGLA55 RENFCSC20 PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 9 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ 9 100. METHANOL COMPATIBLE WffRP (Pnmuy Tani) ❑ 9 BRONZE ❑ 10 GALVANRSD STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ I RUBBER LINED ❑ 2 ALXYO LNING ❑ 3 EPDXY LINING ❑ a PHENOLIC LININGC.:LININGR ❑ 5 GLASS LINING ❑ 5 UNLINED ❑ 93 UNKNOWN ❑ 99 OTHER IS LINING MATERIAL COMPATIBLE WITH t00.METHANOL 7 YES_ NO_ O.CORROSION ❑ I POLYETHYLENE WRAP ❑ 2 COATING ❑ ] VINYL 'WRAP ❑ A FIBERGLASS BEINFORC90 PLASTIC PROTECTION ❑ 5 CATHOLIC PROTECTION❑ 91 NONE ❑ 93 UNKNOWN a 99 OTHER I . ?!PING INFORMATION CIRCLE AIF ABOVE GRCUNO OR U:F UNDERGROUND.30TH FAPPLICABLE A. SYSTEM TYPE A U I SUCTICN A U 2 PRESSURE A U ] GRAVITY A U W OTHER 3. CONSTRUCTION A U I SINGLE WALL A U 2 DOUBLE WALL A U ] LNED TRENCH A U 95 UNKNOWN A U A OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE IPVC)A U A FIBERGLASS PIPE CORROSION A U 3 ALUMINUM A U $ CONCRETE A U 7 SEELW/COATWG A U 1100% MEMANOL COMPATIBLEWIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATWMICPROT'ECTICN A U 95 UNKNOWN A U N OTHER 0. LEAK DETECTION ❑ 1 AUTOMATIC LINE LEAK OE—,.CTOR ❑ 2 LINE 7GHTNESS TESTING ❑ ] •N r"1 99 OTHER MCKRGaNO l_I J'x,IV.TANK LEAK DETECTION❑ 1 VISUAL CHECK ❑ 2 INVENTORY RECONC0.uTCN ❑ ] VAPOR MONITORING❑ a AUTOMATIC TANK GAUGING❑ S GROUND WA—.R MONITORING ^ ❑ S TANK TESTING ❑ 7 NTERSTITTALMONRORNG ❑ 91 NONE ❑ 95 UNKNOWN ❑ " OTHER L`7 VI.TANK CLOSURE INFORMATION 1.ESTIMATED GATE LAST USED(MWOAYNRI 2.ESTIMATED QUANTITY OF I WAS TANK FILLED WITH SUBSTANCEEREMANWYES 6 GALLONS INERT MATERIAL? C-] NO❑ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF,4fY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME IPwMtIOa SKvMN� LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF T HE FOUR NUMBERS BELOW 3 UX �l1 COUNTY x JURISDICTION t FACILITY S �--�—ANK�x;�� 75STATE 1.04M PERMIT NUMBER �I ^ I I I PERMIT APPROVED BYICATE I PERMIT EXPIRATION CATS FORM B !11-90 THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION•FORM A.UNLESS A CURRENT FCRM A HAS BEEN FILO. �� :an9m.Bu