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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 1 aha�o <br /> (Two pallesperteak) <br /> OJ��J��.JJC Page__L of Z <br /> TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 4.AMENDED PERMIT ❑ $.CHANGE OF INFORMATION ❑ 6.TEMPORARY TANK CLOSURE 430. <br /> (Clivi aall) ❑ 3.RENEWAL PERMIT ❑ 7.PERMANENTLY CLOSED ON SITE <br /> (Spsify Kamal (Spedry+mov) ❑ S.TANK REMOVED <br /> BUSINESS NAME(Syepu FACBIIYNntEEorDBA-Doing Bm®A.) 3. FACILITY ID: 1. <br /> LOCATION WTnM SITE�(opm.o Al8 <br /> NJ <br /> E TANK DESCRIPTION- a <br /> .. -T" x s p <br /> with.the'S1tlmtl#ot,of14e2'7&G'sysiem:irrcludmg bnild"mgs aod'ta�d;.;at.shaLL-bcshbmxttaBYo � 1 �d <br /> TANK ID# / 432 TANK MANUFACTURER 433. COMPARTMENTALIZED TANK U Yes Lj No 434. <br /> ,J & IfWea"m�Me os pge rm mdtmoaarv�C <br /> DATE INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS 437 <br /> (YEAR/MO) b <br /> ADDITIONAL DESCRIPTION( io®1 as<oary) 438_ <br /> IL TANK CONTENT'S' <br /> TANK USE.:.. °39. PETROLEUM TYPE 440, <br /> ❑ 1. MOTOR VEHICLE FUEL ❑I& REGULAR UNLEADED ❑2. LEADED ❑5. )ET FUEL <br /> (1(ck tel meylem Pvtolnm TyPc) ❑Ib. PREMIUM UNLEADED ❑3. DIESEL ❑6. AVIATION GAS <br /> ❑ 2- NON-FUEL PETROLEUM ❑Ic MIDGRADE UNLEADED [34. GASOHOL ❑99.OTHER <br /> ❑ 3. CHEMICAL PRODUCT COMMONNAME (ttomWVNm hYtvwbtnwvcNypgc) 441. CAS#(aomH®dom Aamsub7o ,aa) 442 <br /> ❑ 4. HAZARDOUS WASTE <br /> (Ua Uaa4ao <br /> ❑ 95.UNKNOWN <br /> 4 - HL TAN <br /> TYPEOFTANK ❑I. SINGLE WALL ❑3. SINGLE WALL WITS EXTERIOR ❑5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443. <br /> (Check one item only) MEMBRANE LINER ❑95. UNKNOWN <br /> 2 DOUBLE WALL 4. SINGLE WALL IN A VAULT 99. OTHER <br /> TANK MATERIAL-pmmy tint I. BARESTEEL ❑3. FIBERGLASS/PLASTIC 8 5. CONCRETE 0 95.UNKNOWN aaa. <br /> (CS om iemoely) [12. STAINLESS STEEL [34. STEEL CLAD W/FIBERGLASS [IS. PRP COMPATIBLE ❑99.OTHER: <br /> REINFORCED PR <br /> PLASTIC W/100%METHANOL <br /> A. <br /> TANK MATER -secondary tank 01. BARE STEEL 3. FIBERGLASS/PI.ASTIC 8. P CDMI'TIBLE W/l00%MEI'HANOL 0 95.UNKNOWN 445. <br /> (Check ow item only) ❑2. STAINLESS STffi.❑4. STEEL CLAD W/FIBERGL.ASS ❑9. FRP NON-CORRODABLE JACKET [:199.OTHE R <br /> REINFORCED PLASTIC(FRP) ❑10. COATED STEEL <br /> 5. CONCRETE . <br /> TANKINTMUOR LINING 1.RUBBER LINED U 3.EPDXY(ENING 0 5.GLASS LINING 0 95.UNKNOWN 446. DATE INSTALLED 4a7. <br /> OR COATING ❑2.ALKYD LINING ❑4.PHENOLIC LINING ❑6.UNLINED ❑99.OTHER <br /> Cheek oa seta ow <br /> OTHER CORROSION 0 1.MANUFACTURED CATHODIC Ll 3.FIBERGLASS REINFORCED PLASTIC 0 95.UNKNOWN 4411. DATE INSTALLED 449. <br /> PROTECTION PROTECTION ❑4.IMPRESSEN <br /> ED CURRENT [199.OTEBM <br /> f ligbk ❑2.SACRIFICIAL ANODE <br /> SPILL AND OVERFILL YEARINSTALLED 450. TYPE ssl. I OVERFE<LPROTECTIONEQIEPMENT: YEAR INSTALLED tl2 <br /> (Cheek all tlmt apply) ❑1.SPILL CONTADPAENT ❑1.ALARM _ ❑3.FILL TUBE SHUT OFF VALVE <br /> ❑2.DROP TUBE ❑2.BALL FLOAT_ ❑4.EXEMPT <br /> ❑3.STRIKER PLATE <br /> a: XW T,iNK LEAK WmC�L01 <br /> (A ci scnptim of the monitoring program s6alfhc - :tb-the tacat agcacv) <br /> IF SINGLE WALL TANK 453. IF DOUBLE WALL 1ANK OR TANK WITH BLADDER <br /> (Cl-k all thin apply) (Check one ibm aoly) <br /> ❑1. VISUAL(EXPOSED PORTION ONLY) ❑S.MANUAL TANK GAUGING(MTG) ❑1.VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑2.AUTOMATIC TANK GAUGING(ATG) ❑6.VADOSE ZONE ❑2.CONTINUOUS PNTERSTITIAL MONITORING <br /> ❑3.CONTINUOUS ATG ❑7.GROUNDWATER ❑3.MANUAL MONITORING <br /> ❑4. STATISTICAL INVENTORY RECONCILIATION ❑8.TANK TESTING <br /> (SIR)+BIENNIAL TANK TESTING 0 4. OTHER <br /> V:TANK CLOSURE INFORMATION I PERMANENT. n a s;naR_ <br /> ESTIMATED DATE LAST USED(YR/MOMAY) 45$ ESTD4ATEDQUANTITYOFSUBSTANCEREMAINING4 TANKPEI-EDWIDIINRRTMATERIAL7 4T/. <br /> 'Il.. ❑Ya ❑No <br /> UPCF hwtwm-b(1/99)-V4 hmp://www.utudocs.org Rev.ovifil00 <br />