|
05/20/2009 13:53 2094E 38IVIRONMENTAL ��LTH
<br /> � I PAGE 03/04
<br /> 1.6 � ifllt° i �(lu1l1)
<br /> 16 )lia��° a lb��J
<br /> UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK
<br /> OP7SRATING PERMIT APPLICATION-TANK INFORMATION OneFo m c us
<br /> E OP ACTION (Cheek ono item only, Fora UST permanrnt elosurc orrenlo5yl,eomplate and this vection and
<br /> I,NEW PERMTI 3.RHNEWAL PERMIT Y Seetionl I,IT,IIl,TV,and iX hetow) ,Ja
<br /> 6.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE S)TE ❑ s,CHANGE OF INFORMATION
<br /> DATE UST PLRMANENTLY CI.03C.D; �� f1 .UST RBMOV
<br /> DATE HXISTINO VST DISCOVERED: (/�,t/,r .�� uob
<br /> rgcalrrlDn(MBenryoaoDty) 1. FACILITYINFORMATTON
<br /> BUSINFS$NAME(Same u FACII,I'Ty NAME or DRA•DolaR Hwiness As)
<br /> BUSTN S / 7
<br /> C IN city Y a
<br /> TAWma _ - i^SIw Il TANKDESCRIPTION
<br /> �4 �- J TANK F CTURER ,.41 iM�_cONFIOURATION:THIS TANK II
<br /> �i-A 3TANt1•�ALDNS TANR 131
<br /> Q 2.ONB W A ARTMENTM UNIT•
<br /> DATE U$TS D +Je TA A�^�+'�.....:...n...s fes" CO AR��In NevMc
<br /> �'� MBBR.yIp N j{i 7'HE VNII ur
<br /> TANK USEMOTOR VF]RCLE FUELING I TANK USEAND CO S 2-
<br /> 07.CNIIDUCALPRODUCTSIORACE 16.MARINAUS WAS ❑ Ia AVfATIONFUAINO ,Jy
<br /> 06.OTHERCFNERATORFUSI AZARDOUB WASTE(IPeh O S.EMERGENCYtlENEXATOR FUEL
<br /> CONTENTS PemoLHUM: E 9f.0 0 99.OTHER( mi 1: Msci2WIJ(sIl
<br /> 0 Ia REGULAR UNLEADED ❑ IC'MIDGRADE UNLEADED Q Ie.PREMIUM p9,
<br /> ❑ I,DIE'SSL C.J.JEr FUEL
<br /> ❑ I.PETROLEUM BLEND PUA 0 9,OTHSR PETROLEUM Q 6,AVIATION O�A,9L�D� IIv
<br /> NON.PEIHOLBUM:[] ].USeO On. ❑ Io.ETEANOL I N N6!
<br /> I I.OTHFJt NDN•PGTROL m Obi
<br /> A NOL
<br /> rvae OP TANK IV.''TANK CON$TRUCTTON
<br /> PRIMARYCONTAINMENT SINGLE WALL LDOUBLH WALL 99.UNKNOWN
<br /> •STEEL ❑ 7.FIBERGLASS 61 INTERNAL ULADDHA IIr
<br /> SECONDARY O]NTAINb{ENT 7.STEEL+IN]'P,RMALLTNINO a6.INmo. 99,OTHER 14
<br /> 0 1.37561, 7.FIE5ROLA39 ❑0.1i%THRIORMEMBRANBLMER 7./ACKETEp NN
<br /> OVERMLLP VFN IoN 'NONE 95.vNRWN >g.OTRER S Ne
<br /> I.ANO ,
<br /> U07$Li AVIS VAL ALARMS 2.BALL FLDATNL
<br /> Q1.TANK McBT$RB
<br /> J.FILL TORESHVT-OPPVALVE
<br /> POI '
<br /> QUTABMBNTS REXEMPT)ON PROM OVERFILL PREVWITON EQUIPMENT
<br /> V. PRODUCT/WASTE PIPING CONSTRf7CTION
<br /> SymfONSTRUCI70N 1YPE .SPIGLE•WALLED 7.DOUBLE.WALLHD 99.OTNER
<br /> PRIMA r CGh I.PAL•SSURS 2 ORAVfiY
<br /> PRIMARY CONTAWMEN7 NVENTIONAL3 C71 A.SAFE SUCTIONgo. "CCR tet .
<br /> /v 1'STS F[BERGLA99 1.FLEXIBLE4.
<br /> SECONDARY CONYAINM6NT Q L TEENLE 0 95.UNKNOWN 0 99,OTBER eel 0 10,RIGWPLASnc y1
<br /> 1.FIBERGLASS I.FIEXIBLE 10,RIGID PLASTIC ,Ala
<br /> PIPNCWTVRBINECON AINMENT SUMP TYPE 139S.UNKNOWN ❑99,DTHER 3 CC] I 1616
<br /> 1.SDICLb WALT, 3.bOUBtlt WALL 'MC
<br /> V(.VENT,VAPOR RECOVERX 90.NONE ,w1
<br /> VENT PRiMnRY coNrAINMENT ) RISER/FI.I.L I'VE PIPING COpNS'I'&UCI'IQN
<br /> 1.STSEi. I.PIBBRGLA$9 ID.RIGID PLASITC O,N NE
<br /> VENT SECONDARY CONTAINMENT O 99.pTNCR(Spairy) 1 e
<br /> LSTEA /.FIBEROLA99 1,1110,RIGID PLASTIC Islet
<br /> VR PRIMARY CONTAINMENT •NONE 99.OTHER(Spcclry) ,s,r
<br /> I.STEA 1,F1BptOl ....001D PLASTIC Iun
<br /> VR SECONOM1RY tnNTAINMQIT NONE 99.OTHER(3paifY) ,616
<br /> 1.STHEL 1,FIEEROLART 10.R101D PLASTIC +e1 I
<br /> VHNTPVXJM TMNSTDON SUMP TYRE I.SINGLE WALL .NONE 99.OTN51((IPeclb) 416
<br /> RISHR PRIMARY CONTANMFNT 1.$AEA LUG-M ID W6PVALL ,NONE ,6161
<br /> 1.FIBERGLASS IO.AIOPLA INT
<br /> RISER SECONDARY COMA[NM6M NON 99.OD{6R(Specify) 166
<br /> I.STEA 1.FTEEROLA39 10.1U01D PLA9DC 1 1
<br /> FICC CV M➢ON6NT3INITALL6D I. 'NONE 99.Qn16R(Spenfy) ,67k
<br /> SP[LL BVCK67 ].STRIKER PLAIFlBpTTOMFROT6CTOit 1.CONTAINMENT SUMP 4601
<br /> STRUCTIONTYP6
<br /> VII•UNDER DISPENSER CONTAINMENT(UDC)
<br /> CON ❑ 1.9rNGLE WAµ
<br /> CONSTRUCTION MATBRIAI O 10 10.RIGID?WALL 7,NO O13PHNSERS ,+9e
<br /> I.BTBH, a.FIBERGLASS RIGID? STIQ 90.NONE
<br /> ❑ 99,OTIHiA E eel
<br /> VDI. CORROSIONPRUIMM70N
<br /> STEEL COMPONENi'PAOTEC770N 02.SACRIFICIAL ANODE( QA.IMPRESSED CURRENT i
<br /> I%, APPA E2 6.IS DLA71ON NL
<br /> CERTIFNA71ON lf" dwttbb UST lyslevels eelnpAtlble wllh thohuud ulBanbN/rin ohored ARdlh}t We htfermetien ,
<br /> Rnd In Nll rnm Iim"Ce with i I r drelllebtl. Provided hernia 4 true,saanlq
<br /> APPLiCANTsm4ATURE DATE
<br /> APPLICAN'(.NA),E(pririt) -
<br /> 1 TTjT,E
<br /> UPCF UST.B_In
<br /> Rev.[72,400'1)
<br />
|