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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 7 <br /> rhw Rases Pe,tank) <br /> Papa _ m <br /> TYPE OF ACTION ❑1.NEW SITE PERMIT ❑ 4. AMENDED PERMIT ❑ 5. CHANGE OF INFORMATION) ❑ e. TEMPORARY SITE CLOSURE <br /> (Check wn Ham aftj aayy� <br /> Ma 7 PERMANENTLYCLOSED ON SIT <br /> 113.RENEWAL PERMIT (Spaa/yreaacn-Mioaluaaway) (SpaMy charge-AfrlpcM uas oM <br /> � ❑ S. TANK REMOVED 4b <br /> BUSINESS NAME(Same at FACILITY NAME w DBA-Doirg Suaimss Aa) FACILITY ID N q 1 <br /> r(a.9ap D s -iNG. f€ I <br /> LOCATION WITHIN SITE(OptiorM9 4 <br /> 1.TANK DESCRIPTION <br /> TANK 100- <br /> ITA NK MANUFACTURER COMPARTMENTALIZED TANK Yea Na <br /> Va l O V UKAOU ) -Yea', omP�eanepope aea h amps nt <br /> MTE INSTALIE (YF.ARIMO) TANK CAPACITY IN GALLONS NUMBER OF COMPARTMENTS <br /> MlriS a6 ► Gam' <br /> A" LDESCRIPTION JF&b .ft aMy) <br /> II.TANK CONTENTS <br /> TANK USE AM PETROLEUM TYPE <br /> ., 1. MOTOR VEHICLE FUEL ❑1a. REGULAR UNLEADED 112. LEADED J Cl 5, JET FUEL <br /> Aae�Lpn9HaM Pa9oA°m ryp) ❑lb. PREMIUM UNIEAOEO IJ&3. DIESEL L(al Cl S. AVIATION FUEL <br /> ❑ 2. NON-FUEL PETROLEUM 1c. MIOGRADE UNLEADED ❑ 4. GASOHOL ❑N. OTHER <br /> ❑ 3. CHEMICALPRODUCT <br /> ❑ 4. HAZAROWS WASTE(lrtluesa COMMON NAME(M1om Hazanaoua Mareaala Inwnrorypa9e) CAS A(Imm Mazartloua wmd ft M.W.,ym.) <br /> U d'" <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 1. SINGLE WALL ❑ 3. SINGLE WALL W1TH El5. SINGLE WALL WATH INTERNAL BLADDER SYSTEM <br /> (Cock.item wrly) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 0 95. UNKNOPTI <br /> ❑ 4. SINGLE WALL IN A VAULT [IN OTHER <br /> TANK MATERIAL-wimWY MM, LN BARE STEEL ❑ 3. FIBERGLASS/PLASTIC ❑ 5. CONCRETE 0. UNKNOVM <br /> (CMckp Ham OMy) ❑ 2. STAINLESS STEEL ❑4. STEEL CLAD WIFIBERGLASS ❑ e. FRP COMPATIBLE W/1W%METHANOL 11 N. OTHER <br /> REINFORCED PLASTIC FRP) <br /> TANK MATERIAL-xwmdery Wk 01. BARE STEEL ❑ 3. FIBERGLASS I PLASTIC ❑ B. FRP COMPATIBLE W11W%METHANOL 09. UNKNOWN <br /> (CMak on Ham-W I ❑ 2. STAINLESS STEEL ❑ 4. STEELCLADWIFIBERGLASS ❑ 9. FRP NON-CORRODIBLE JACKET 09. OTHER <br /> IJy�„ REINFORCED PLASTIC FRP) 1110, COATED STEEL <br /> K ❑ 5. CONCRETE <br /> TANK INTERIOR LINING 0 1. RUBBER LINED ❑ 3. EPDXY LINING ❑ 5. GLASS LINING 095. UNKNOWN433 DATEINSTALLED <br /> OR COATING <br /> ❑ 2. ALKYD LINING ❑ 0. PHENOLIC LINING ❑ B. UNLINED 099. OTHER <br /> orr Herr) Farlowl use <br /> OTHER <br /> PROTECTION <br /> CORROSION IF ON ❑ 1 MANUFACTURED CATHODIC ❑ 3. FIBERGLASS REINFORCED PLASTIC ❑95. UNKNOWN 431 GATE INSTALLED <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 0. IMPRESSED CURRENT 1199. OTHER <br /> (Chock orw Ham orr117 ❑ 2. SACRIFICIAL NODE (Forbcal use pMy) <br /> $RLL AND OVERFILL YEAR INSTALLED TYPE(ForkKWl ory) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check a a I"t apply) 1 SPILLCOWAINMENT ❑ 1. ALARM ❑ 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE ❑ 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> W. TANK LEAK DETECTION <br /> IF SINGLE WALL TANK Chock ad h t apply) IF DOUBLE WALL TANK OR TANK WITH BLADDER(Chock ww Ram 0MY). <br /> ❑ 1. VISUAL(EXPOSED PORTION ONLY) ❑ S. MANUAL TANK GAUGNG(MTG) ❑ 1. VISUAL(SINGLE WALL IN VAULT ONLY) <br /> ❑ 2. AUTOMATIC TANK GAUGING(ATG) ❑ S. VADOSEZONE ❑ 2. CONTINUDUSINTERSTITIALMONITORING <br /> ❑ 3. CONTINUOUSATG ❑ T. GROUNDWATER ❑ 3. MANUALMONITORING <br /> ❑4. STATISTICAL INVENTORY RECONCIUATION(SIR). ❑ $. TANKTESTING - <br /> BIENNIAL TANK TESTING 0. OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DAT VLM(YRINOm Y) ESTIMATED QwRV B NCE EMAINING 435 TANK FILLED VATH INERT MATSRML? <br /> 11Yaa ❑No <br /> A' Li- Lo <br /> r S <br /> CUPAFORM(4/99) r('�'a��� tI ""� FoRRBrly SWRCB Foml 8 <br />