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UNIFIED PROGRAM CONSOLIDATED FORM BANKS <br /> EE_ UNDERGROUND STORAGE AN KS T� PAGE 1 g)g pages Perlank) <br /> '-/ P.Q. of <br /> ❑ S. CHANGE OF INFORMATION) ❑B.TEMPORARY SITE CLOSURE <br /> TYPE OF ACTION 91.NEW SITE PERMIT ❑ A.AMENDED PERMIT 0 T PERMANENTLY CLOSED ON SITE <br /> (Ce kau B.m rnM <br /> ❑S.RENEWAL PERMIT (SpetiH maon� f5peaycAerge-brloralmeonry9 ❑ . TANK REMOVED ASB <br /> FOIA <br /> AME(Samea,FACILITY NAME m DBA.Dokq Suaimu b) <br /> FAGLRYIDO <br /> � �Az-s Fh�ly f NSITETOP".4 ASt O <br /> 1.TANK DESCRIPTION ❑ Ne <br /> TANK MANUFACTURER 1. <br /> COMPARTMENTALIZED THN ena pe a fO aMawmp~nt- <br /> .TANK IO• rye/ II Nei,FwnpaIa 9 <br /> � 3 `^ TANK CAPACITY IN GALLONS NUMBER COMPARTMENTS <br /> DATE INSTALLED(YEARMO) <br /> ?Ire 2- <br /> o <br /> ADDITIONAL DESCRIPTION f lr euae orYki <br /> IL TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE Q DED Q S.JET FUEL <br /> ❑ 1. MOTOR VEHICLE FUEL Oq1 REGULAR UNLEADED 0 5.AVIATION FUEL <br /> puLW. REMIUMUNLEADED S. DIE <br /> fVMrxW,mmpbb Rlmisum Type)❑ 0 A. GASOHOL ❑99. OTHE0.2. NCH.FUELPETROLEUM pRA <br /> ,MIOGDE UNLEADED <br /> CAS t(M1onl HazeNaw McNNMa Inwnbrypepe) <br /> ❑ S.CHEMICALPRODUCT COMMON NAME(han HazMRova MaMMMIm+MpOrpe9s) <br /> ❑ A. HA2ARDOUSWASTERnHedea <br /> U.e Dig <br /> .111.TANN CONSTRUCTION <br /> 0S. SINGLE WALL VATH Q 5. SINGLE WALLWITH INTERNAL BLADDER SYSTEM <br /> TYPE OF TANK ❑ 1. SINGLEWALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> fO kp RemeM ^2. DOUBLEWALL 0 q. SINGLE WALLIN A VAULT 00. OTHER <br /> ,ay ❑95.UNKNOWN <br /> TANK MATERIAL-Wim"l>nL ❑ 1_ BARE STEEL tL 5. FIBERGUISS I PLASTIC 0 5. CONCRETE <br /> (Clwcxom Asm oNyl ❑ 2. STAINLESS STEEL Q A. STEEL CLAD WIFIBERGLASS 05 FRPCOMPATIBLEWII(D%METHANOL ❑99.OTHER <br /> REINFORCED PLASTIC IFRP <br /> TANK MATERUL-eewk+lY lenx 0 1. BARE STEEL Q S. FIBERGLASSIPLASTIC 01. FRP COMPATIBLE W/IDD%METHANOL ❑B5. UNKNOWN <br /> ft;peck ale gem-W ❑ 2. STAINLESS STEEL ❑ A. STEEL CLAD WMSERGLASS 0 9. FRP NON-CORRODIBLE JACKET <br /> ❑B9.OTHER <br /> REINFORCED PLASTIC(FRP) 010, COATED STEEL <br /> ❑ 5. CONCRETE DATE INSTALLED <br /> TANK INTERIOR LINING <br /> ❑ 1. RUBBER LINED 0 S. EPDXY LINING 05 GLASS LINING 095. UNKNOWNaS] <br /> OR COATING 0 A. PHENOLIC LINING 06. UNLINED ❑99.OTHER orb f. <br /> ❑ 2. ALKYD LINING PATE INSTALLED <br /> necx om Aem 1 Au <br /> OTHER CORROSION Q 1. MANUFACTUREOCATHODIC ❑ S. FIBERGLASS REINFORCED PLASTIC 099. OTHER <br /> PROTECTION IF APPLICABLE PROTECTION Q A. IMPRESSED CURRENT <br /> (Forbceluv oMy) <br /> fClnklm,Aem. Q 2.SACRIFICIAL ANOOY INSTALLED TYPE(ForbW ua only) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> SPILL AND OVERFILL <br /> eppyl ❑ 1.ALARM -� Q S. FILL TUBE SMIR OFF VALVE <br /> (CAeckq IAN ❑ 1. SPILLCONTAINMENT <br /> ❑ 2. BAIL FLOAT_- Q A. EXEMPT <br /> ' ❑ 2. DROP TUBE <br /> Q S. STRIKER PLATE _ <br /> I3- IF DOUBLE WALL TANK OR TANK WITH BLADDER C9ecF one item <br /> IF SINGLE WALLTANK CMd0th.l• ❑ 5. MANUAL TANK GAUGING(MTG) 0 1. MSUAL(SINGLEWALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(EXPOSED PORTION ONLY) Q5 VADOSE 2010E ❑ 2. CONTINUOVSINTERSTITIAL MONITORING I <br /> 0 2, AUTOMATIC TANK GAUGING(ATG) ❑ T GROUNDWATER Q 3. MANUALMONITORING <br /> 03, CONTINUOUS ATO 0 9 TANKTESTING <br /> Q A. STATISTICAL INVENTORY RECONCILIATION(SIR)• <br /> BIENNIALTANKTESTING 0- OCHER <br /> V.TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LAST USED(YWMGDAY) ESTIMATED QUANTITY OF SUBSTANCE REHMINING <br /> ASS TANK FILLED WITH INERT MATERIAL2 <br /> pePena Q Yee ON. <br /> FormerlY SWRCS F01TII <br /> CUPAFORM(4109) <br />