Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM 1 <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE <br /> 91 per rank) <br /> Page_of <br /> TYPE OF ACTION .YEW PERMIT ❑ 4.AMENDED PERMIT ❑ S.CHANGE OF INFORMATION O 7.PERMANENTLY CLOSES 6.TEMPORARY TANK ON S +10. <br /> SITE <br /> IChck wm nanmq) ❑ 3.RENEWALPERMCC <br /> (Spcilyr, l (Sp fy,mo°) ❑ e.TANK REMOVED <br /> I. <br /> BUSINESS NAME(S..FACILITY NAME I DBA-DMZ 9aamaa.v) 3.TFACILITYID: <br /> �(1j4L7 L c- s 3 `f <br /> +31. <br /> LOCATION WITHIN SITE(Opco°4 <br /> L TANK DESCRIPTION <br /> (A scaled plot plan with the location of the UST system including buildingS and land nmrlabe�.AATMENTALI�ZED TTANK to the lag Y) 0 41a. <br /> LJ <br /> TANK ID x a31 TANK MANUFACTURER <br /> '/// if' m m i..One page fm ac6 OO-V� <br /> DATE INSLLED +35. TANK CAPACfTY IN GALLONS 436. N-LIti1BER OF COMPARTMENTS +17. <br /> TA / <br /> (YEARIMO) C J) /(� ,5-00 <br /> ADDITIONAL DESCRIPTION(For kcal°ae o°ly) <br /> II.TANK CONTENTS <br /> uo. <br /> TANK USE +39. PETROLEUM TYPE <br /> ❑ I. MOTOR VEHICLE FUEL ❑11. REGULAR UNLEADED ❑2. LEADED ❑5. I'ET FUEL <br /> O(chakad cwmiee Pemkwn T>pel ❑lb. PREMIUM UNLEADED ej�MIESEL ❑6. AVIATION GAS <br /> ❑ 2 NON-FEEL PETROLEUM ❑Ic. MIDGRADE UNLEADED ❑4. GASOHOL ❑99.OTHER: aaZ <br /> u1. CA$�(ham Hazudous MatmWa Invenwry Page) <br /> ❑ 3. CHEMICAL PRODUCT COMMON NAME (6om Xanrdau M-als l°vemory page) I <br /> ❑ 4. KALaRDOCSWASTE <br /> (Include Uvd Oil) <br /> .UNXYOR'N <br /> M.TANK CONSTRUCTION <br /> TYPEOFTA.NK kLj. SINGLE WALL 3. SINGLE WALL WITH EXTERIOR 05. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> M1. <br /> MOON) MEMBRANE LINER 095. L\TCYOWN <br /> (Check ane i <br /> ❑2. DOUBLE WALL ❑+. SINGLE WALL IN A VAULT ❑99. OTHER 95.UNKNOWNO+a. <br /> TANKMATERIAL-p,,y, & - BARE STEEL ❑3. FIBERGLASS/PLASTIC 5. CONCRETE <br /> (mak.-�,) ❑2. STAINLESS STEEL 134. STEEL CLAD W/FIBERGLASS C1 S. FRP COMPATIBLE ❑99.OTHER: <br /> REINFORCED PLASTIC(FRP W'/TDO%METHANOL <br /> TANK MATERIAL-secondary odc I. BARE STEEL 3. FIBERGLASS/PLASTIC S. FRP COMYT®LE W/IOOY.METHANOL 09s <br /> TANK <br /> +as. <br /> (Check one item ody) ❑2. STAINLESS STEEL ❑4 STEELREINFCLAD <br /> PLASTIC(LAPS C390. COATED STEEODABLE JACKET 13 99.OTHER <br /> ❑5. CONCRETE _ <br /> TANK INTcR10R[1NlYG I.RUBBER LINED 3.EPDXY LINING 5.GLASS 1.IM.YG wN a+6. DATE INSTALLED uT. <br /> OR COATING ❑2 -W&_ALKYD LINING ❑4.PHENOLIC LININ -W&_UNLINED [399.�R <br /> Check oneaem oniv) <br /> OTHER CORROSION 1.MANUFACTURED CATHODIC ❑a.BMPRESSED CURRENT PLASTIC ❑99 OTHER <br /> wN aae. DATE INST <br /> PROTECTION PROTECTION <br /> If A licable) 2.SACRIFICIAL ANODE <br /> D 45L <br /> SPILL AND OVERFILL YEAR INSTALLED +so. TYPE 451. O'ERFD1. A PROTECTION EQRM UIPMENT fi HINGF^ALE _ <br /> (Check all IbJ apply) O0 1.SPILL 2 DROP CONTAINMENT [3AINMEN2B <br /> - ALL FLOAT_ ❑4. SPT <br /> TUBE <br /> ❑3.STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> (A description of the monitoring program shall be subndttcd to the local agency.) _ <br /> +v. IF DOUBLE WALL TANK OR TANK WITH BLADDER <br /> IF SINGLE WALL TANK (Check one item only) <br /> (Check all,hac WPMUALTANKGAUGING(MTG) ❑ 1.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 1. VISUAL(E.'BOSED PORTION ONLY) ❑sMAN � CONTINUOUS INTERSTITIAL MONITORING <br /> ❑2. AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE - <br /> ❑3.CONTINUOUS ATG ❑T-GROUNDWATER ❑3.MANUAL MONITORING <br /> ❑4.STATISTICAL LNVENTORY RECONCILIATION ❑S.TANK TESTING <br /> (SIR)-BIEYrIU.T..N-K TESTING ❑99. OTHER <br /> V.TA`iK CLOSURE IlVFORMATION/ PERr1`1`lENT CLOSURE INPLACE 437 <br /> +s s. 056. TANK FILLED WITH INERTMATERIAL7 <br /> ESTIMATED DATE LAST USED(YRMO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REV WLNZYG ❑YM ❑ No <br /> gallons <br /> Rev.022/16/00 <br /> F rtnt//www.un idoea.ort <br />