Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -TANK PAGE 1 <br /> (Mn pages per lank) <br /> Pape <br /> TYPE OF ACTION 01.NEW SITE PERMIT 0 4.AMENDED PERMIT 0 5. CHANGE OF INFORMATION) 0 S. TEMPORARY SITE CLOSURE <br /> (CMckarn tern only) 0 T. PERMANENTLY CLOSED ON SITE <br /> 03.RENEWAL PERMIT (Speeiynsaon-brlagalun-Hr1 (SpeayeAuge-brbc-luseorlM 0 B. TANK REMOVED 430 <br /> BUS/IN�ESS1N'AMf+E(Some as FACILIT Dome BVMness al FACILITY 100 1 <br /> Y ` THI <br /> LOCI-WITHIN 51 (OpBonFpA 1 T� 4]1 <br /> %7N{ Jgefv <br /> I.TANK DESCRIPTON <br /> TANK IDe rt TANK MANUFACTURER COMPARTMENTALIZED TANK D Vea n <br /> ��{�/��y(/F�-� II•Ysi ramDlale one page:w earA mmpadmenl. <br /> DATE INSTALLED(YEARR.g) TANK GPACITYIN GALLONS NUMBER OF COMPARTMENTS <br /> �O <br /> ADDITIONAL DESCRIPTION(Forbcal uss oMy) <br /> II.TANK CONTENTS <br /> TANK USE 432 PETROLEUM TYPE <br /> 0 1. MOTOR VEHICLE FUEL 01a. REGULAR UNLEADED 0 2, LEADED 0 5. JET FUEL <br /> (IImaM1W,mmpen PofnNum Type) 01D. PREMIUM UNLEADED 0 3. DIESEL 0 5. AVIATIONFUEL.. <br /> D 2. NON-FUEL PETROLEUM 0 to MIDGRADEUNLEADED 0 4. GASOHOL X. OTHER ��!-!�D I� v ✓y <br /> 0 3. CHEMICALPROOUCT COMMON NAME(hom Ha2alloua MeladLa Inventory Paps/ CASe(/nm Haxartloua MahI ls.mwpape) <br /> X. 1UZARDOUS WASTE(IrcbWss <br /> Used GO <br /> 13 95. UNKNOWN <br /> III.TANK CONSTRUCTION <br /> TYPE OF TANK 1. SINGLE WALL Cl 3. SINGLE WALL WITH 0 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM <br /> (Check P/M dem a*) ❑ 2. DOUBLE WALL EXTERIOR MEMBRANE LINER 095. UNKNOWN <br /> 0 4. SINGLE WALL IN A VAULT D 99 OTHER <br /> TANK MATERIAL-pdmary ISM1. BARE STEEL 0 3. FIBERGLASS I PLASTIC 05, CONCRETE 095. UNKNOWN <br /> (Cm arM ilem ardy) ❑ 2. STAINLESS STEEL D 4, STEEL CUD W/FIBERGLASS 0 8. FRPCOMPATIBLEW/l00%METHANOL ❑99. OTHE0. <br /> REINFORCED PLASTIC(FRP) <br /> TANK MATERIAL.secondary tank1 BARE STEEL 0 3. FIBERGLASS/PLASTIC 08 FRP COMPATIBLE W1100%METHANOL 095. UNKNOWN <br /> (CAeckphelbmooly) ❑ 2. STAINLESS STEEL 0 4. STEELCLAD PLASTIC 09 <br /> 9'FRP NON-CORRODIBLE ACKEi 099. OTHER <br /> REINFORCED ❑10. COATED STEEL <br /> 0 5, CONCRETE <br /> TANK INTERIOR LINING DATE INSTALLED <br /> OR COATING ❑ 1. RUBBER LINED ❑ ]. EPDXY LINING ❑ 5. GLASS LINING 095. OTHER N4]3 <br /> 0 2. ALKYD LINING 0 4. PHENOLICUNING UNLINED ❑99. OTHER (FarkcNws <br /> Aeck orn B-m o DATE INSTALLED <br /> OTHER CORROSION 0 1 MANUFACTURED CATHODIC 0 3. FIBERGLASS REINFORCED PLASTIC 95. UNKNOWN 434 <br /> PROTECTION IF APPLICABLE PROTECTION <br /> ❑ 4. IMPRESSED CURRENT 098. OTHER (Far lauluasDM9 <br /> (Cheek mle dem oMy) ❑ 2. SACRIFICIALANODE <br /> SPILL AND OVERFILL YEAR INSTALLED TYPE(Forbcelua..*) OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED <br /> (Check-I that-PPM ❑ 1. SPILL CONTAINMENT 0 1. ALARM 0 3. FILL TUBE SHUT OFF VALVE <br /> ❑ 2. DROP TUBE 0 2. BALL FLOAT ❑ 4. EXEMPT <br /> ❑ 3. STRIKER PLATE <br /> IV.TANK LEAK DETECTION <br /> IF SINGLE WALL TANK Aeek-Olheta IF IbUBLEWALLTANKORTANKWITHBLA00ER Chee ,,"_ <br /> 0 1. VISUAL(EXPOSED PORTION ONLY) 0 5. MANUAL TANK GAUGING(MTG) ❑ 1. VISUAL(SINGLE WALLIN VAULT ONLY) <br /> 0 2. AUTOMATIC TANK GAUGING(ATG) 0 S. VADOSE ZONE 0 2. CONTINUOUS INTERSTITIAL MONITORING <br /> 0 3, CONTINUOUSATG 0 T. GROUNDWATER 0 3. MANUAL MONITORING <br /> D4. STATISTICAL INVENTORY RECONCILIATION(SIR) S. TANK TESTING <br /> BIENNIAL TANK TESTING ❑0, OTHER <br /> V.TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE <br /> ESTIMATED DATE LASTUSPD(YRIMOIDAY) E5TIMATED QUANTITY OF SUBSTANCE REMAINING 435 TANK FILLED WITH INERT MATERIAL? <br /> W,k_✓q�/ palbns D Yes D No <br /> - ! 8- D0 <br /> Formerly SVVRC8 Form B <br /> CUPAFORM(4199) <br /> `e, �� <br />