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05/20/2909 13:53 209464'_'9 le 1 ENVIRONMENTAL F+'TH PAGE 03/04 `a a)r6��o UNIFIED PROGRAM CONiO-LWATE RM ,F. UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION T e fottn vs PE OP ACT10N (Check one item only. Fora UST INefmaAL PERMIERMIe of ttmOVAI,CORI only this+action moi$aetlam J,H,I14 TV,end TK below) tSn 1.NEW PERMIT 3.RENEWAL T ❑ 5,CHANGE OF INFORMATION 6.TEMPORARY UST C[AStlRE 7.UST PERMANENT CLOSURE ON SITE .UST REMOVA DATE UST PERMANENTLY CLOSED: �f11LYJ OW DATUMSTINOUSTDTSCOVERED: 1. FACILITY INFORMATION PACiL7Y ID n(Agmry Uir Oily) _ _ I BUSINESS NAMB(Servo u FAC]LrN NAME Or DBA-Defog i i j o, i 13V. $ Iry CITY � Seo c,�To 101 r y 7 0 r IL TANXDESCRIPTION TANKIDa -1 IA FLMANUFAC7URER QI` T CONPIWMT70N:THIS TANK IS 124 " ) w� NO,ALONETANK ❑2.ONE IN AATMBNTBD UNIT. ATE LIST IS fiD wt TA CA CITY IN OALLDNS m' "n,min 6E unit E FCC; 7 NT JNTNEUNIT u] TANK USE MOTOR VEHICLE PUELINC wSl AND CONTEN'C$ L- .MARINAPUELING ❑ t UTIONFUELINO 439 13 3-CHEMICAL PRObULT STORAGE ❑ t. �Ui WASTEVadiee Uedp% .BMSRGENCY OENERA70R FUEL S.OTHERCENERATOR FUEL 95.UNKNOW 99.OTHER( i )1 (RSC1JD91J(c)) ❑ 1& p91 CONTENTS ❑PBTRDLKUM: REGULAR UNLEADBD ❑ la MIIX)RADE UNLEADED E3I.DIESEL ❑ S.JHr PUEL 18.PREMRIMUNLEADPD 10 ❑ 9.PSTROLBUMBLENDPI)EL ❑9.07MER PETROLEUM LJ e.AVIATiON DAs NON•9TOROLBUM: 7.USeD OIL ❑ IO.fiTNANOL 1 /Y 114 rl IL OTNPJt NON•98TROLEUAI Bei 4401, TYPE OF TANK M 'TANK CON SINGLB WAIL LDOUBLH WALL 95. KNOWN I'MMARYWINTAINMENT ,STEEL ❑ 3.FIBERGLASS W e,INI%XKALBLADDER w3 7.STEEL+INTERNAL LIMING 095.UNKNOWN 99.Otuslt444 SECONDARY CONTAINMENT ❑ I.STEEL J.FIBEROI.ASS ❑S.IOCTER70R MEMBAANELTNEit 7.ACRETED Itee .NONB ❑ 95.I1NRNOWN 99,OYt[E0. J ed OVERFILL PAEVENDO I,AUD/BLFA ViSVALALARMS Z.BALL PLpAT use D/.TANK MEETS R J.PVE T ION EQ T•OPP VA-1 I ' EQUI)TFMENT$PORFXEMP170N PROM OYBR]TLL PREVENTION BQVI9MENT '1//9 V. PRODUCT/WASTE PIPING CONSTRVCPION PIPING CON UCITON 1.SINGUi•WALLED 7-DOUeLEWALLBD ❑99.O7HER SYSTEMTYPE I.PRESSVAH I.OAnvrrY NV15NTIONAL SUCTI 4.SAFE SUCTION J5071 u . ] w 40 PRB.LARY COM'AWM61IT� I.STEEL ❑ CFIBERGLA99 ❑ B.FLEXIBLE /V ❑90.NONE ❑ 9S.UNKNOWN 1]99.OTHER ccib' 10.RIGID PLASTIC yt SECONDARY lbT1YAINMENT I.STEEL /.FIBERGLASS B,FLEXIBLE464NONE I7 95.UNKNOWN 13 99.OTEER 9 ed 1 10,RIGID PLASTIC tub PIPMC B1N8 CONI'NNMENT SUMP TYPE I.SPIOLEWALL 2.DOUBLEWALL � VL VENT,VAPOR RECOVERX 90.NONE Iua VENT PRIMARY CONTAINMENT I, )' RISER./FILL PxhE PIPING CONS'.I'RUC'I'ION STTiB{. !.PI88AGLA$$ U 10.RIGID PLASTIC 0.NONE 99.OTHER(SPeeiiy) VENTISOMOARYCONTAINMENT Q LSTEEL C3 1.PIHEAOI.A9S 10.11 PLVSTI .NONE 99.OTHER(sptI turT VRPWMARYCONCAl1tMQ1r 1.$IEEE I.F7Hat01 10.RIGID PLASTIC .NONE 99,OTNER(9pedfY) ! VR SEOpNDARY CONTAMMQtT L.STEEL I.FIBEROLASg 10.AIOID PLASTIC e61I .NONE 99.p7N8R(Specify) 11th VENTPRIN TRANS177 $UMP TYPp 1.$1NCLE WALL .1111 Ri38R PAIMARY[ONTAINMENT LDOUBLE WALL .NONE 1.STEFL 1.FIHEAOLA53 10.RIGID LAST NONE pp.Om� Ie1L R1SBR38CONpARY CONTAOVMBM (3P1+b) 111 - 1,STEEL /.In88ROLA5S 10.AIO1D PLASTIC N 1 I oxE 99.arN6a(spet;rr) 111 FILL COMPDNeNTS INSTALLED 1.9PILL BUCKET 3.3TRBC8R PLATF/BOTTOM PAOTBCrOR /.CONTNNMBNT SUMP � v VPI.UNA]sR AISPENSF3t CONTARVIVIEN 1 (UDG� CONSTRUCTION 7798 ❑ 1.91NGI.H WALL []3.DOURER WALL CONSTRUCTION MAIRRtµ I.57Efl, ❑/,FlBERGLA55 10.RIGID PLASTTC ❑ 99NOTHp,RPES S� 90•NpNe wye V1TL CORROSIONPROTECTION' . ee96t 3IEPL ODatPONENTPRUTB0770N ❑ =.SACAff[CTAL AN DOES) 6/.I1,11PRESSEDCURREN7 ❑ e. 1 ISOLATION .1 CERTTPICATION:ice rtlrydrat thq UST P IX' APPLICANT SIGNATURE . rritem b tem atlb)e whh the hazardou!InbrtantI mored and shpt the tnformatlen provldM lernk V fna exori.fq and In fail) IinFee With al r dremente. APPLICANT SIONATU /} DATE APPLICANT NAME(pr(ih)- 111 LTC 'rrag , UPCF UST-B-Ia 7 Rev.(17!7007)