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• . Io�i3�DH 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 ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON SITE ONE ITEM �2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 8 TEMPORARY TANKCLOSUREDq 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: � LD `7 a3 S I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN /( 0. MANUFACTURED BY: J D. TANK CAPACITY IN GALLONS: C. DATE INS7ALLE0(MOMAV/YEAfl) A/ .. ILTANKCONTENTS IF A-1 IS MARKED.COMPLETE ITEM C. la REGULAR UNLEADED 3DIESEL ❑ 6AVIATIONGAS A ❑ 1 MOTOR VEHICLE FUEL ❑ 4 OIL B. C. Ib PREMIUM UNLEADED 4 GASAHOL ❑ 7 METHANOL ❑ 2 PETROLEUM ❑ 80 EMPTY ❑ 1 PRODUCT g 7e MIDGRADE UNLEADED ❑ 5 JET FUEL ❑ 8 M85 ❑ 3 CHEMICALPRODUCT ca 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER(DESCRIBEINTEMB.BELOWI C.A S.M: D. IF(Xi)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED /sem III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C,AND ALL THATAPPUES IN BOX 0 AND E A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3' SINGLE WALL WITH EXTERIOR UNER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN r: SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT ❑ 99 OTHER SYSTEM �UBANE STEEL ❑ 2 STAINLESS STEEL Q 3 FIBERGLASS ❑ 4 MEL CLAD W1 FIBERGLASS REINFORCED PLASTIC B. TANK ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP MATERIAL F75 CONCRETE (PHmary Tang ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY UNING ❑ 4 PHENOLIC LINING C.INTERIOR �95 UNKNOWN ❑ 99 OTHER LINING OR F75 GLASS.LINING ❑ 8 UNLINED COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP ❑ 4 FIBERGLASS REINFORCED PLASTIC CORROSION �yg7 NONE ❑95 UNKNOWN ❑ 99 OTHER PROTECTION ❑ 5 CATHODIC PROTECTLOLI SPICOCONTAINMENT INSTALLED(YEAR) OVERFlLLPREVENTION EQUIP DISPENSER CONTAMMENT YES_ NOS E SPILL AND OVERFILL,BTO. DROP TUBE YES__ NO STRIKER PLATE YES____ NO_ IV.PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IFAPPUCAELE A. SYSTEM TYPE A U SUC A U 2 PRESSURE A U 3 GRAVITY A U s:FLEXIBLE PIPING- A U 99 OTHER B. CONSTFIUCTION A U SI GLE 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 0 R A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER 1 MELNANICAL UNE LEU( C]2 UNE RGNOaESS Q 7 C�pNmTN IlQ 4 MCmIXaO PUMP Q 99 MIER ^y�v D. LEAK DETECTION ❑ restn+o 6AN° ` pE1ECTOP V.TANK LEAK DETECTIONANNUAL 2 MANUAL INVENTORY ❑ 3.MONITOR ❑ 4 GAUGING C TANK ❑5 GROUNDWAMONITORING TER ❑8 TESTING =CON ❑ pECONCIUATION 9 WEEKLY MANUAL ❑10 MO NTITHHLY TANK ❑ 95 UNKNOWN -� DTH ER RSTITIAL ❑ 8 SIR ❑ TANK GAU LNG VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) ❑ —72.ESTIMATED QUANTITY OF / 3.WAS TANK FILLED WITH YES NO 1.ESTIMATED DATE LAST UUSi(MONAY/YR) �-GALLONS INERT MATERIAL? LL SUBSTANCE REMAINING THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERI RY,AND TO THE BEST OF MY KNOWLEDGE, DEIS TRUE AND CORRECT TANK OWNER'S NAME /� a LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW TANK a COUNTY M JURISDICTION A FACILITY K �I STATE I.D.# m I PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUSTSHOULD BE ACCOMPANIED BY A BY AI PLOT PLAN. FILEFTHIS FORM WITH THE LOCAL AGENCY IMPLEMENTINGTHE UNDERGROUND STORAGEEANK REGULATIONS INSTALLATIONS.THIS FORM