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10(131 aN STATE OF CALIFORNIA STATEWATEA RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION -FORM 8 I COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON SITE MARK ONLY I NEW PERMIT ONE REM 2 INTERIM PERMIT 714 AMENDED PERMIT ❑ 8 TEMPORARY TANn� DBA OR FACILITY NAME WHERE TANK IS INSTALLED: /,4)16 Lo /nK� CLOSURE g TANK REMOVED /c. 6 c*2.3 A rp I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN 4 8. MANUFACTURED BY: A OWNER'S TANK L 0.• J 7 D. TANK CAPACITY INGALLONS: C. DATE INSTALLED(MdDAY/YEAR) GV II.TANK CONTENTS IF A-t IS MARKED.COMPLETE ITEM C- a AVIATION GAS ❑ I MOTOR VEHICLE FUEL ❑ 4 OIL B. C. 1a REGULAR UNLEADED A 3 DIESEL ❑ 1b PREMIUM UNLEADED 4 GASAHOL ❑ 7 METHANOL 2 PETROLEUM ❑ SO EMPTY ❑ 1 PRODUCT 1c MIDGRADE UNLEADED ❑ 5 JETFUEL ❑ 8 M85 ❑ ❑ 3 CHEMICALPRODUCT 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER(DESCRIBE N ITEM D.BEO'M D. IF(A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.M: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B,AND C,AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ❑ i DOUBLE WALL ❑ 3SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM E�?4 SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER B. TANK BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM C:] 8 100%METHANOL COMPATIBLE W/FRP (Primary Tok) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER 1 RUBBER LINED ❑ 2 ALKYD UNING ❑ 3 EPDXY UNING ❑ 4 PHENOLIC LINING C.INTERIOR ❑ ❑ 8 UNLINED E[95 UNKNOWN ❑ 99 OTHER LINING OR ❑ s GLASS LINING , COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO— D.EXTERIORI POLYETHYLENE WRAP F] 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION �y 9'1 NONE ❑93 U PROTECTION NKNOWN ❑ 99 OTHER ❑ s CATHODIC PROTEcnor SPILL (YEAR) OVF I—-PREVENTION EQUIPMENT INSTALLED(YEAR) CONTAINMENT INSTAUED E SPILL AND OVERFILL,8t0. DROP TUBE YES__ NO STRIKER PLATE YES NO DISPENSER CONTAINMENT YES__ NO IV.PIPING INFORMATION- CIRCLE A IF ABOVE GROUND OR U IFUNOERGROUND,BOTH IF APPLICABLE A, SYSTEM TYPE A U SUC A U 2 PRESSURE A U 3 GRAVITY A U 4 FLMSLEPIPING. A U 99 OTHER B. CONSTRUCTION A U SI LE 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 R A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE NCRETE A U 7 STEEL W/COATING A U B 100% METHANOL COMPATIBLE W/FRP CORROSION A U 5 ALUMINUM A U a CO PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER GG 1 YEGHWC4 UNE IE0( 2 UNE MJIOlES ❑7 N VrfEASfRLLL ❑!BECTaOMC LaIE ❑5 AVf FVYP ❑99 OTHFA -t/CW— D. LEAK DETECTION ❑ 9ETECTOR ❑ TE511MI rFAN° V.TANK LEAK DETECTION 2 MANUAL INVENTORY ❑ 3.MADOTZOFLNG ❑ ` GAUGING C TANK ❑9 MON TORINGGROUND TER ❑ 8 TESTING TANK ❑ ]oNnNuous AL CHECK ❑ RECONCIUATON 9 WEEKLY MANUAL ❑10 MONTITHHLY TANK ❑ 95 UNKNOWN - 9 OTHER INTERSTITIAL ❑ B $IR ❑ TANK AU IN VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 2 ESTIMATED QUANTITY OF (�/y��/ &WAS TANK FILED WITH YES ❑ NO 1 ESTIMATED DATE LAST /(CO/DAYnR) SUBSTANCE REMAINIG ��6ALLONS INERTMATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJ RY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT' TANK OWNER'S NAME c /L9 e (PNaiTFD 8510NANPE) /` LOCAL AGENCY USE ONLY( THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW TANK# COUNTY# JURISDICTION# FACILITY# STATE I.D.# m PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORK MUSTSHOULD BE ACCOMPANIED BY AI PLOT PLAN. FILETHISFORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK INSTALLATIONS. THIS FOR