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Sen- by: HML UtSIUN UHUUH; /0/7656835; Feb-3-99 10:57AM; Page 4/4 STATE OF CALIFORIMA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION-FORM 8 0 ( (� COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. \V� MARK ONLY 1 NEW P6RMrT 3 RENEWAL PERMrr ❑ 5 CNMN;E OF INFORMATION ( � 7 PSRMANEN%Y ON sm ONE ITEM 2 INTERIM PERMIT ® 4 AMGNC 0 PERMIT ❑ I TEMPORARY TANK M=RE ! TANK REMOVED DEA OR FACLn Y NAME WNERE TANK K INSTALLED: 1. TANK DESCRIPTION common ALL Ricw sPOCIFY IF UPM04OWN A.OVIRM TANK L 0.• -.O - 9 MANUFACTURED BY; G OATS INSTALLED(MCICAY/TEAR) 110 0-TANK CAPACITY IN QALLONB: 515 II.TANK CONTENTS IF M1 16 MARKED,COMPLETE REM C. A. 0 i MOTOR VEHICLE FUEL 4 OIL El C, It AMHIA.AR UN LEADED3 DEML b AVIATION GAB ❑ 2 PETHOLELIM ❑ !q HMAPTY ❑ t PRODINCT Ip PIL4MIN LVA M01 B 4 OAaAmm 7 METHANOL /o MDORABE Ul�EAOED S .ILiTRIEI 8 MSS ❑ 7 Ci19AMCN PROOLrCT ❑ M UNKNOWN 2 WA9TL Y LEADED 09 OTHER ID®CF6E R REM 0.BApIM) 0. IF(A 1)16 NOT MARKED.£NM NM*OF SUBSTANCE BTORED - 121 L ITL TANK CONSTRUCTION mom ONE mim ONLY IN was A 4 AND C.ANO ALL THAT Amim IN wx O MID E A. TYPE OF wl 1 ooms WALL ❑ 3 BINDLE WALL WITH ExT@MOR LINER F-] 9 INTERNAL BLADDER TMTEM 71 09 umom SYSTEM ❑ 2 SINGLE WALL ❑ 4 O NGLE WALL M A VAULT ❑ 99 OTHER B. TANK ❑ 1 BARE STEI L ❑ 2 sTAONLESS$Te& (4 3 FIBERGLASS ❑ 4 STEEL cLAD WV PIBERO ms RemmRCED PLAsnc MATERIAL ❑ S CONCRETE ❑ I POLYVMfYL 04LORIDE ❑ 7 ALIMNUMA ❑ a 100% METHANOL COMPATIBLE WIFW (PomT Two ❑ 9 BR mm ❑ is QALVAm=STEEL ❑ a NPNr mmm ❑ 99 orm C.IN it" ❑ I RUSSIN UN3O ❑ 9 ALKYD LANG ❑ 3 EPDXY LINING ❑ 4 PWNOM LINING L ffma OR ❑ 3 MASS LINING ® a UNNLINIM ❑ GS UNMOWN ❑ 99 OTNNEL COAT1N0 tg LINING MATERIAL COMPATIBLE Wm+ 100%METHANOL? YF6— NO— D.EXION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL wRAP 4 MBERGLASS REINFORCED PLASTIC PROTECTION ❑ 3 CATHODICPMTECTIM ❑ 41 NONE CD 06 UNWANM I00 OTHER fM SPILL AND OYERFILL.9L0. I r A/NM "Y (v LL E INBTAueo W"PROPTlW,"1M "Y NO STRIKER PLAYS YES NO DNSPENSERCCTNTARMENT YEB NO IV.PIPING INFORMATION CIRCLE A IF ABCVE AROJM7 OR U rF UN WMMUND,BOTH W APPIICA1111.4 A. SYSTEM TYPE A U 1 S=ON A U 2 PRN'30URE RM 3 GRAVITY A V 4 PLEXBLE PIPBKH A U Po OTHER 8. CONSTRUCTKNN A U 1 am=wALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 93 uNmovm 99 OTHER C. M ATFJMAL AND A V 1 BARD 417111E1. A U 2 STAIN M STRIL. A U 3 POLYVINYL CH+LDRIDE(PVC)A U 4 PISEF4LASS PIPE CORROSM A U 6 AL.UTAM M A U 9 CONCWTE A U 7 STEELW COATING A U 9 iou%METHMIOL COMPATIBLE WIMP PROTECTION A U 9 12ALVMIQm SMEL A U IO CATNOOIC PROT60RON A U 96 UNW40MAV A w OTHER 0. LEAK OETEC ION Ej1 WuYAw6U NE talc [:12 Zr' ©3 oaNn4rors■m m144 ❑4BL'C"W1 IPE ❑1 AYrOrYflR.R�r 90 oI►rr•11 Y.TANK LEAK DETECTION ❑ 1 VIBL)fiL CH6cK ❑ 9 MAmuft W4104TORY ❑II M � F-14 DTIC TAW ❑S WATER6 momrmpmTE TANK ❑ 7 CONTiNUOUB MMSYMAL ❑ a ❑2 WEIBO.Y MAN1IAL❑10 MAORHLY TANK ❑ 95 URKNOWN ❑9Ni OTHDI TAwmmm TESTING VL TANK CLOSURE INFORMATION tMK3aMANarr momp f wftAm I.E$ITMAUSED YMti 2.ZITIMATED OLLMMI!Y OF 3.WAS TANK FILLIP WITH $UBBTAWMA MAININO GALLONS INERTMATERIAL? YES GATE ❑ NO THis Pow HAS BEEN coAo E rED UNDER PEIIALTY OF PERJURY,AND To me wsrOF MY KNOWL.E'DeE',IS TRUE AND CORRECT' TANK OWN$"NAME DATE gno m a alNIuTURQ I ___j LOCAL AGENCY USE ONLY M STATE I.C.MN=R M C=PMM OF 7 E FOUR M MBMS BELOW COUNTY 9 .IJRLSRimcm N FACKAY 9 TANK* STATE l.D.A m PERMIT NuMNlER PERMIT APPROVED 6"MI Ti PERMIT 100"ATION DATE THIS FORM WXr BE AOCOMPWW BY A FERMI APPMTKIM-PMA,UIM_ M A CINRIR W FUN A WS BI IN FLM FOIMA c MUNI BE COWLETED FOR INSTALLATIONS.IM R m N XUA BE ACCOM MIM BY A PLOT PLAIL PK.RTIAI MM Wn THE LACAL A011l W WLEMI M THE UNIMI MMIO 6RWGE TAW NW"MM FORM 0 (946)