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STATE OF CALIFORNIA fes. <br /> STATE WATER RESOURCES CONTROL HOARD <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM 8 <br /> COMPLETE A SEPARATE FORM FOR° CH TANK SYSTEM. <br /> MARK ONLY a i NEW PERMIT 1 RENEWAL PERMIT 5 CHANGE OF; ;NFOAMATION �� 7 PER=.REMOVEO �i <br /> ON SITE <br /> ONE ITEM a 2 INTERIM PERMIT F7 6 AMENDED PERMIT 9 TEMPORARY TANK CLOSURE L._! 8 TAN/�DBA OR FACILITY NAME WHERE TANK IS INSTALLED: /VI �- M art Y�C <br /> I. TANK DESCRIPTION COMPLETE ALL ITEMS- SPECIFY IF UNKNOWN q / <br /> A. OWNER'S TANK 1.0.s v, 8. MANUFACTURED BY: <br /> C. OAT'c !NSTALLED(MO10AYIYEAR) 0. TANK CAPACITY IN GALLONS: y 0W <br /> 11.TANK CONTENTS IFA-1 IS MARKED.COMPLETE ITEM C. <br /> I I MOTOR VEHICLE FUEL a OIL 3, i C. taREGUtaR 3 DIESEL r— o AVIATION GAS <br /> ❑ i_ uNLEAOEO u <br /> F� 2 PETROLEUM ❑ 30 EMPTY 2: 1 PRODUCT ib PREMIUM L–J s G`T FUEL 7 METHANOL <br /> —, `-' UNLEADED � 5 :ET FUEL –"' <br /> E J 3 CHEMICAL PRODUCT C::] 95 UNKNOWN E] 2 WASTE I El 2 LEADED I� 99 OTHER (DESCRIBE IN ITEM 0. SELOWI <br /> 0. IF(A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.s <br /> 111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A.3.AND C.AND ALL THAT APPLIES IN BOX D AND E <br /> A. TYPE OF ❑ 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN <br /> SYSTEM 1 :: SINGLE WALL ❑ a SECONDARY CONTAINMENT (VAULTED TANK) u 99 OTHER <br /> S. TANK �' 1 BARE STEEL 172 STAINLESS STEEL ❑ 3 FIBERGLASS ❑ a STEEL CLAD Wl FIBERGLASS REINFORCED PLASTIC <br /> MATERIAL ❑ 5 CONCRETE ❑ 3 POLYVINYL CHLORIDE 7 ALUMINUM -- 8 100% METHANOL CCMPATIBLE'.V;FRP <br /> (PrimaryTank) 9 BRONZE 10 GALVANIZED STEEL. 95 UNKNOWN j 99 OTHER <br /> 1 RUBBER LINED } 2 ALKYO LINING ❑ 3 EPDXY LINING i a PHENOLIC LINING <br /> C.INTERIOR ❑ 5 GLASS LINING S UNLINED 95 UNKNOWN 99 OTHER <br /> LINING <br /> IS LINING MATERIAL COMPATIBLE WITH 100%METHANOL? YES_ No— <br /> D. <br /> O_D.CORROSION ❑ I POLYETHYLENE WRAP 2 COATING 3 VINYL WRAP a FIBERGLASS REINFORCED PLAS i�C <br /> PROTECTION ❑ 5 CATHOOIC PROTECTION 91 NONE UNKNOWN 99 OTHER <br /> E.SPILL AND OVERFILL SPILL CONTAINMENT;NSTALLZ-0(YEAR) OVERFILL PREVENTION EQUIPMENT INSTLLEO(YEAR) <br /> IV.PIPING INFORMATION CIRCLE A;F ABOVE GROUND OR U IF UNDERGROUND.90TH IF APPLICABLE <br /> X SYSTEM TYPE A(!?l A(!? 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 39 OTHER <br /> H. CONSTRUCTION A l SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER <br /> C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL.CHLORIDE(PVP A U a FIBERGLASS PIPE <br /> CORROSION A U 5 ALUMINUM A U a CONCRETE A U 7 STEEL AU COATING A U 3 100% METHANOL COMPATIBLE WIFRP <br /> PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER <br /> D. LEAK DETECTION C:] 1 AUTOMATIC UNE LEAK DETECTOR 2 UNE'1GHTNESS TESTING <br /> 40NRORING 199 OTHER <br /> V.TANK LEAK DETECTION <br /> Q 1 VISUAL CHECK ❑ 2 INVENTORY RECONCILIATION 1 3 VAOOZE MONITORING t_J a AUTOMATIC TANK GAUGING F71 5 GROUND WATER ER MONITORING <br /> 8 TANK TESTING 7 INTERSTITIAL MONITORING ❑ 91 NONE ❑ 95 UNKNOWN 99 OTHER <br /> VI.TANK CLOSURE INFORMATION <br /> 1.ESTIMATED OAT LAST USED(MQ10AYtYli) 2 ESTIMATED QUANTITY OF 3.WAS TANK FILLED `O( UANS INSGALLONS I INERT MATERIA � <br /> THIS FORM NAS BEEN COMPLETED UNDER PENALTY OF PERJURY,ANO TO THE BEST OF MY KNOWLEDGE .S TRUE ANO CORRECT <br /> APPLICANTS NAME OATS <br /> (IM MTED a SIGNATURE) <br /> LOCAL AGENCY USE ONLY THE STATE I.D.NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOWCOUNTY:t JURISDICTION FACILITY s TANK 0 <br /> STATE I.D.Y g !� i I f�t 11 i 7 I L Lo-1-z- <br /> !s % <br /> PERMIT NUMBER PERMIT APPROVED BY/OATS - PERMIT EXPIRATION DATE r VIA-- <br /> FORM 8 (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION-FORM A,UNLESS A CURRENT FORM A HAS 8 EN FILED. <br /> -vv .' <br /> / ''LJ . <br />