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• �3 i C�YY�{'� 6e�L 1-ON � �� STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 I COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT E] 3 RENEWAL PERMIT [D 5 CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ONSITE 6 TEMPORARY TANK ONE ITEM 2 INTERIM PERMIT F14 AMENDED PERMIT /❑ �CB TANK REMOVED CLOSURE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN iii A OWNERS TANK L D. 1 Ti D 5 15— TAO �TANK TURED BV: G DATE INSTALLED(MO/OAYNEAR) PACITY IN GAUANS: II.TANK CONTENTS IF A-Y IS MARKED,COMPLETE ITEM C. ❑ 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C. 71b EGULAR UNLEADED 3 DIESEL ❑ B AVIATION GAS A. REMIUM UNLEADED 4 GASAHOL ❑ 7 METHANOL 2 PETROLEUM ❑ SO EMPTY ❑ 1 PRODUCT IDGRADE UrLFAOED 5 JET FUEL ❑ 8 M` ❑ 3 CHEMICAL PRODUCT 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER(DESCRIBE W REM O.BELOW) D. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.9: ------------ III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A,B.AND C.AND ALL THAT APPLIES IN BOX D AND E r7I DOUBLE WALL ❑ 3SINGLE WALL WITH EXTERIOR LINER 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN A. TYPE OF �� ❑ 99 OTHER 11---- SYSTEM /�,f SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT B. TANK —99:j BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ❑ 5 CONCRETE ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE WIFRP (Primary Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER UNED ❑ 2 ALKYO UNING ❑ 3 EPDXY LINING 4 PHENOLIC UNING C.INTERIOR LINING NG OR ❑ 5 GLASS UNING ❑ 8 UNLINED (5{95 UNKNOWN ❑ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION y91 NONE ❑95 UNKNOWN O 99 OTHER PROTECTION ❑ 5 CATHODIC PROTEC71 - — SPILL CONTAINMENT INSTALLED(YEAR) OVERRLL PREVENTION EGUIPMENT INSTALLED(YEAR) E SPILL AND OVERFILL.a10. DROP TUBE YES_ NO_ STRIKER PLATE YES__ NO_ DISPENSER CONTAINMENT YES_ NO IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUND,BOTH IFAPPUCABLE A. SYSTEM TYPE A U SUC A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLEPIPING. A'U 99 OTHER B. CONSTRUCTION A U SINGLEWALL A U 2 DOUBLE WALL A U 3 UNED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WICOATING A U 8 100% METHANOL COMPATIBLE W"P PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER 5 1 MECHNaGLL UNE LF.1K 2 UNE TlC NEEM ❑3 CoNNAWa WIFASTIML ❑A FIECIRCIaC UNE AVIONABC AAF99❑ OTHER ��Pkl7�. D. LEAK DETECTION ❑ 0 m=n ❑ uoNroNnw lFAN ctTEcroR ❑ sNlROovm V.TANK LEAK DETECTION 2 MANUAL INVENTORY ❑ 3.VADOTOERING ❑ 4 GAUGG AUTOMATIC TANK ❑5 MON TORING�R ❑ 8 ANNUALTESTNGTANK ❑ 1 VISUAL CHECK ❑ RECONCIUATION ❑ 7 MONITOR N6 INTERSTITIAL Q 8 SIR ❑ 9 WEETANK GA'M Mo ❑10 MESNTHGV TANK ❑ 95 UNKNOWN OTHER VI,TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 2 ESTIMATED QUANTITY OF��LLONS 3WAS INERTMATERIAL? YES ❑ NO� I.ESTIMATED DATE LAST U75F�D7(MO/OAYNR) SUBSTANCE REMAINING THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJ RY,AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT TANK OWNATE ER'S NAME (PRIME04 SIONATURM LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY# JURISDICTION F FACILITY# TANK STATE I.D.# m [� PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE THIS FORM MUST SH BE ACCO P DIED ByJDPERMIT APPLICATION- BYA PLOT PLAN. FILETHISFORM WITH THE LOCAL AGENCY IkIPLEMENTING THE UNDERGROUND STORA E TANK REGULATIONSNS.THIS FORT