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Nov 23 09 09: 55a RAVIN# SINGH 209 47656 p. 5 UNIFIED PROGRAM CONSOLIDA'T'ED FORM n . UNDERGROUND STORAGE TANK ' =um OPERATING.PERMITAPPLICATION-TANK INFORMATION(one rotm TYPE OF ACTION (Choat one item only. h"or an UST pamulxnt cloture or lamavel,oompkw only this sectio end Sc'cfiom 1,%111,N,and IX below) 00 ❑ 1.NEW PERMIT ❑ 3.RENEWAL PERMIT LAYS.CHANGEOF INFORMATION 6,TEMPORARY UST CLOSURE 7.USTPFRMANENTCLOWRE ONSITE 0 S.UST REMOVAL DATE UST PERMANENTLYCIOSED: EDAM EXISTING UST DISCOVERED: 41eb I. FACILITY INFORMATION FACILITY ID 9(9galcy Use Omy) BUSINESS NAIVE(Sema o FACHM NAME or DBA-Doing Bnmoen As) ) BUSIN bSTTEADDRESS lis' CITY O 2f/. /.afA.eTr .dam SToc.r]'�'� IL TANK DESCRIPTION TANK LD# p •u TANK MANUFACTURER Ul 7coNFuwRnnar:.1. rArttu O [y 1,n xrANo-Aw rernw ��`� � ❑2.ONE IN A COMPARTMENTED UNIT. J cem laser Mum bar uN,. DATE U '1'SEM INSTALLED TANK CAPACITY IN GALLONS Aw NUMBEROF COMPARTMENTS DI THE UNIT ')1 TIL TANK USE'AND CONTENTS' 'DANK USE a MO TOR VEHICLE FUELNO 13 Ib,MARINA FUELING ❑ ICAVIATWNFUO.NO 4J9 I] I.CHEMICAL PRODUCTSTORAOE ❑4.IlA2ARDOUSWASTE(Indwdr IhW0q) Q 5.EMERGBNCYGEN�ATORPUELCMC§=SI-5(c)I Q 6.0THERGERERATORFUEL O 95,UNKNOWN ❑ ".OTHER S CONTENTS PETROLEUM: CI y1 REGULAR UNLEADED Q la M1DORADEUNIEADED Q Ib.PREMIUM UNLEADED Mo ( , DIESEL ❑5.IETFM Q 6.AVIATION OAS ❑ S.PETROLEUM BLEND FUEL 13 9.OTHER Ph"TIt01EUh1 S 4a0. NGN.rh=LEUM:O 7.USEDOIL 1D.ETIUNOL II.OT7IF,RNON.PFTROLF.UM . MOb g TANKCONSTRUCTION TYPE OPTANK 1.3INOLE WALL .WUtlLE WA 95.UNKNOWN 40J PRIMARY CONTAINMENT .STEEL Q I.FIBFROLAM UQ INTERNAL BlADDBR W 7.STEEL+N1tRNALLNING 9.S.IEYKTRIWN 99.01111Rt R �e SECONDARY CONTAINMENT' I.STBBI. 3.FTBERUlA9S 6.P.)t'IERIOR MEMBRANE LINER ,SACRRTED M5 00.NONE. 0 95.UNKNOWNw.OTFffiR 443s OvwwtLL r"VENTION I.AUDIBL86 VLSIIM.ALARMS 2.ISAU.PIgAT .PRL MDR Sl=.OPP VALVE 43L 04.TANKMBETS REDURUDMENIS FOR KXFMPfION FROM OVERFILL PREVENTION EQUIPIMENT V. PRODU .f WASTE PIPING CONSTRUCTION .` PIPI40170n5TRUCYN)N I.SINGLE•WALL® .DOUBLB•WALLPD w.rrDINR 160 SYSTEMTYPP. I.PHESSURE 2 RAV[IY ].CONVENYIONALSUCT10N 4.SAFESUCT'ION CCR N ) 4se PRIMARY CONTnNMENT I.STEEL .FIBERGLASS U S.FIEKTBLE LO.RIGIDPLASTIC 44a ❑9V.NONR ❑ 9 .UNKNOWN ❑99.OTHEU3 464. SECONDARY CONTAINMENT 1,STEEL .FIBERGLASS P.FLBRIE a ImwGIDPLANnC 4646 ❑90.NONE ❑ 9 .UNKNOWN ❑99.OTHER(Spoc*)• 464a PVTNWLL fVRBINE CONTAINMENT SUMPTYPE .SmCiLB WA2,DOUBLE WAIL Ll 90.NONE 46"6 VI vEN P,VAPOR RECOVERY ON AND RISER I FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT I.STEEL .FIDEROLA33 U lu,R IDPIASTIC TT 90.NONE 99.OTHER(Spaufy) 4644 aM.l VENT SECONDARY CONTADPMENT CI I.STEEL 0 4.FIBERGLASS U 10.RIGID PLASTIC 95 .NONE U99.OTHER.(Spaify) 4646 464G VR PRIMARY CONTAINMENT 0 1.STEEL .FIBERGLASS Ll 10.RIGIDPIAST[C El%-NONE CI99.OTHER(sp..W) 4646 464AI VR SECONDARY CONTAINMENT C31.Vr9VL 0 4.FIBERGLASS El 10.RIGID PIAtirIC .NONE 0 99.OTHER RSpwo) 4646 <GI,I VENI'PIINN ,'TRANSRIONSIIMPTYPE ISINGLEWALL 7DOUBLE WALL FU74.NONE KISPR PRIMARY CONTAINMENT CHWI.S'rehl. U 4.viBERGl Aac IU.RRimrlA IC W 90,NONE U 9%OTHER(Spae10') 4641 aM I mkK SECONDARY CONrAINMUNJ 0 I.STBEL CPIBERGLA59 Lj ImmwpL tlC 94.NONR LI MOrnaiLispw) Moe 46*1 PILL COMPONENTS INS'TALLFD W.SpjLL3rCW W.STRIKIIRPaTMICITTOMPROTECTUR. 041.CONfAINMENTSUMP 01" VII.UNDER DISPENSER CONTAINMENT.(IMQ CONSTRUCTK)NTYFF. -SNOLEWALLQ LDOUBLE WALL Q 7.NO DISPENSERS Q 90.NONE 46W CONSMUCDON MATERIAL .STGEI. 4.FMSROLASS 10.RIOIDpLASnC u 99.OTHER((SP.*) 469Le VIII. CORROSION PROTFMON STEEL.COMPONENT PROTECTION ❑ 2,SAMM'IALANODE(S) Q 4.IMPRESSED CURRENT 13 6.ISOLATION 418' ,•.��y,./p DL APMCANTSiGNATURE . yENTIM[CATION: I w nify that tw,VST system N c rnpatible wBh the hasard0as sahstaoee stored and Hitt the Infunmation pr klcd htnla It true accurate. =4 la full enns U Ree with Irequlre)IMntt. 4rv. APPLICANT SIGNATU ' DAY- 411' APPLICANT TCT(,E APn.lcwxr xaME fprlal), /�OF.0 •^ i/ ��i�i✓E.� UPCF U$T'+e.1T2 Rw,(IY/200n