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_ ,1v�ry.JJ ,a1131oN STATE OFCAUFORNIA ,.. ....' STATEWATER RESOURCES CONTROL BOARD O 11(,(6N UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 , 1 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT ❑ 3 RENEWAL PERMIT El CHANGE OF INFORMATION ❑ 7 PERMANENTLY CLOSED ON SITE ONE REM2 INTERIM PERMIT ❑ 4 AMENDED PERMIT /❑ 8 TEMPORARY TANK �CLOSURE 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN A OWNERS TANK I.D.4 7 TA 5 I S 7� B. MANUFACTURED BY: C. GATE INSTALLED(MdDAV/YEAR) 0. TANK CAPACITY IN GALLONS: D ILTANK CONTENTS IF A-1 IS MARKED,COMPLETE ITEM C. 1A REGULAR UNLEADED 3DIES EL ❑ 6AVIATIONGAS A ❑ 1 MOTOR VEHICLE FUEL ❑ 4 OIL e. C. 1E PREMIUM UNLEADED d GASAHOI 7 METHANOL r72 PETROLEUM ❑ 00 EMPTY EE PRODUCT Ic MIDGRADE UNLEADED 5 JETFUEL g 8 M85 ❑ 3 CHEMICALPRODUCT CgEr_95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED 99 OTHER(DESCRIBE IN REND.BELOW) D. IF(At)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A S. III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.B.AND C.AND ALL THAT APPLIES IN B0XD AND E 11 A. TYPE OF ❑ 1 DOUBLE WALL El SINGLE WALL WITH EXTERIOR LINER ❑ 5 INTERNAL BLADDER SYSTEM ❑ 95 UNKNOWN SYSTEM ❑ 99 OTHER SINGLE WALL ❑ 4 SINGLE WALL IN A VAULT �J BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 Fl ❑ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC S. TANK ❑ 8 POLYVINYL CHLORIDE ❑ 7 ALUMINUM ❑ B 100% METHANOL COMPATIBLE W/FRP 5 CONCRETE MATERIAL ❑ (PdMWY Tank) ❑ 9 BRONZE ❑ 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER ❑ 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY UNING ❑ 4 PHENOUC UNING C.INTERIOR ❑ 8 UNLINED (�B5 UNKNOWN ❑ 99 OTHER LINING OR ❑ 5 GLASS LINING COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES— NO— D.EXTERIOR ❑ 1 POLYETHYLENE WRAP ❑ 22 COATING ❑ 3 VINYL WRAP ❑ d FIBERGLASS REINFORCED PLASTIC CORROSIONy,�T gi NONE ❑ 95 UNKNOWN ❑ 99 OTHER PROTECTION ❑ 5 CATHODIC PROTECTIOu SPILL CONTAINMENT INSTALLED(NEAR) OVERFlLL PREVENTION EQUIPMENT INSTALLED(YEAR) E.SPILL AND OVERFILL,BIC. DROP TUBE YES__ NO STRIKERPLATE YES__ NO_ DISPENSER CONTAINMENT YES__ NO IV.PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNOERGROUND,BOTH IFAPPUCABLE A. SYSTEM TYPE A U SUC A U 2 PRESSURE A U 3 GRAVITY A U 4, FLEXIBLE PIPING, A, U 99 OTHER B. CONSTRUCTION A U SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A V 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE C. MATERIAL AND A U 1 CORROSION A U 5 ALUMINUM A U B CONCRETE A U 7 STEEL W/COATING A U 8 100% METHANOL COMPATIBLE WIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER C 1 MEGHMaCLL UNE LEAK 2 LNE ilai11NE58 ❑,3 S IK`R4111VL ❑/F1ECfRONw LIM1E ❑5 AVfoAUTw FVMP ❑ 99 OTHER A�tu(�" D. LEAK DETECTION ❑ DETECTOR ❑ hsTrta �'N oETEcroR V.TANK LEAK DETECTIONANNUAL ❑ 1 VISUAL CHECK ❑ 2 MANUAL I ONITO VENTORY ❑ 3 ATIONMAADOZE NG ❑ 4 AUTOGAUGIING C TANK ❑5 MON TORINGGROUND TER ❑ 8 TESTING TANK ❑ 7 MONRTTORICNG INTERSTITIAL ❑ $ SIR ❑ 9 TAENKGAUGINGAL ❑10 MESNING TANK ❑ 95 UNKNOWN OTHER VI.TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-PLACE) 2.ESTIMATED QUANTITY OF /�/y��/ 3.WAS TANK RULED WITH YES ❑ NO 1 ESTIMATED GATE LAST U�SEU(MO/DAV/YR) SUBSTANCE REMAINING ALLONS INERTMATERIAL? THIS FORM HAS BEEN COMP ED UNDER PENALTY OF PERJURY AND TO THE BEST OF MY KNOWLEDGE,EIS TRUE AND CORRECT TANK OWNER'S NPME C �' / e (PRWTEDb51oNANPE3 /� LOCAL AGENCY USE ONLY( THE STATE I.D.NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW COUNTYB JURISDICTION 9 FACILITY M TANK STATE I.DA m PERMIT NUMBER PERMIT APPROVED BYIDATE PERMIT EXPIRATION DATE THIS FORM MUSTSHOULD BE ACCOIMPABY ANIED BY AI PLOT PLAN.OFILEFTHIS FORM WWITH THE LOCAL AGE CY IMPLEMENTING THE UNDERGROUND STORA ETANK RIE GUTHIS THIS FOR