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Oct 07 10 08:26a Bev (209) 462-9861 p.1 <br /> \0 <br /> 05/20/2009 13:53 2044.40138 'EWIROWbIENTA&I-EALTH �Q \�\\ PAGE 03/04 <br /> ,o l21(0 19J7/la <br /> d'- <br /> VNiFIED PROGRAM WNSOJLtDATED FORM „ „ <br /> UNDERGROUND GE.TANK l�()SS SIC f <br /> OPERATING PERMIT APPLICATION-TANK INFORM 'I'IONI(onofQm crus <br /> E�w E (Clakoncitem oDyRMfU .For UST permmelt cloaurc Arrclno al,aodgteq only dliA aeclien :>teclten>a t,II,iTF,rv,and oC hPlRw) Ir+ <br /> 3.RENEWALPERMIT ❑ S.U 3$AFINFORMATION <br /> 4 TEMPORARY UST CLOSt1RE 7.UST PFRIdANEN[CL09[IRE ' <br /> DAM UST PERMANENTLY CLO SEIk 4rIJ1,W DATE WOSTMO UST DSSC <br /> L FACU.TTI'INFORMATION <br /> rnciurrlDnygmwD I,roRtyJ - <br /> BUSTNE$$NAA1P(Sdme as PAC a 11 as IlUir4a At) T <br /> Im, C1TY iD :;� hL 1 <br /> TANK m 4 IL TANK DESCRIMON -n <br /> T R:MANCJPALTURER <n NPRIcrRATTDN: T'Ee TAMC is 1 <br /> ANK <br /> AJ,J, wNARTUIR4 WUMr. <br /> DA VST SY$T'EbS AJ,y� w T f`-APArrr- .•..... • se :6. eaR.e.mtbN-mk <br /> S (j ,) ^NS'� I�U�iBEIR OP CO. T EUNII .ov <br /> IIT.TAl.NAC ITS®ARD CO 8 <br /> TAMC USB MOTOR VISlc"PUP.I.ING Q Ib.MARMAPURR3i '❑ CC AVfATIDN TUEANG <br /> Q 3.CNEM1GCAL PRODUCfSTORAGe s,RAURDOUS WAWI 00 Q5.lMEROENCVGENSRA7pRFUlL[ASL'iTS1111(dl <br /> ❑ 6.OTNAt GF7:lRATORFLIEL Q 99.OTHER. i <br /> CONTL?fIS PRTIt',1I.dUM: ❑ [e..REOULAR tRJLEADSD O C MIDGRADEUMBADIN Q 1%PItImlum UNLEADED IW <br /> Q J.DIlSEL Q.S.JA[Fm Q6.DATION OAS <br /> El LPBTROLEVMSL@10 N6T. Q 9.OTNlRDhTROLSUM <br /> NON•P�rROLEUM:❑ J.Usm O1L ❑ c0.S[NANOL �� �� <br /> II.OTHPA NON.PISTROLEUM 1106 <br /> TYPE 09 TAN' TANK CON3TRVG7ION <br /> MC sDiCLE WAW. 1DUVBLl WALL <br /> PRIMARY OONtAMMFM .ShFl 1.FME0.GLAS5 Q a,.IATERNALRLADDIaC m <br /> 7.STEEL«iNTBRNAl4cl 95.UNLNOWN 99.OTNyt w, <br /> 98N!(DARY taNTARIMExr L STlFd. 7.FteER99 ❑ L lKTPRIOwri rl ".mNF]R 7.fACKET'ET) Iu <br /> .NONH 9s.um="S3 w.om I MSa <br /> OVERFILL 1,AU018LSA VI$VAL ALARMS a.HALL nLOATS.R7Lt.'1U8l RPNTAPP YAW! <br /> QL.TANK MP.ETS R24NR¢MENTS PORC[@NTTCNPROMOVERFR.L DRlVlN17Ot1 EQG7PMEIT �/9 <br /> V. PRODIICT/grA�P�TGCOLMg., 7YT(ON <br /> PIPING CONSRlUCr1ON I.SdVGLE.WA SD Y USL6WAU.� aP.07FIF�l <br /> SYSTnMTYP! 1.PRL-SSU ORAVRY g1TIpNALSUCT[ <br /> PP.[MAAT CGNfALYMEN'f� I,gT6EL A,SAFSSUCTION <br /> 1.F®ERGLA99 1.P(27C®L! !0.RIGID PLASTIC y1 <br /> NOh'e ❑93.UNKNOWN 99.orm ml(F <br /> SlCONDARY[ONTA1NM91T I.STEEL 1.1BEAGI.A43 Ll A.FLEXI8LEIa4 <br /> UNKNOWN Q 99,Orlin I tA.AIGTD PLASTIC Iaw <br /> P19MGl1SIReCGt CONTNNMlNT SUNDT'rp! i.SRIdE WALL S.DOUeLR WAIL. 1M1 <br /> A.VENT,VAPOR RECOVERY m NONE <br /> VLTIT pgIMARYcohTARrMLT? (VR).ANA$[SER.I I+[Id,,X'A E P WG(,�STRT1CTiON <br /> 1.S'1'E1ZL t.P18EltOLA33 I9.RIGID 9LASTIC NO:I! 99,pTM;F.�I' -rh Tale <br /> VENT 9600lIDARYCONtADLNENT LSTP.EL ♦.FIBFAlO1.A.9$ <br /> IG.RRMPLASTIC <br /> ON 99.01TiPlC(9pedf� 4w <br /> VR PRIMARY CGNTADiM Q1T I.STEEL I.FIHlROLAffi 10.R1mD Pl.ASrIC p batt <br /> NON! 99.OTNPA �� <br /> VR SE[DNDARY CONTARddgT ...y...r,y 61A <br /> 1.STlH. 1.I'I�ROLAq 30.AEE PLASUC .NON! 99.OTTIlR(SpecAy/ au I <br /> VEIA' PRIG N9mCN 9[1MO TYP! LS ,EWALL LODVBLEWALL ��, <br /> WW-PRIMARYCON7AINMFNi LSTHFL 1.F18P]COLAiS '�! <NL <br /> 19.IU 10P AS NONS 9AOtNlR(9DIp¢] <br /> AISDCSECONDARV CONCARAILQr7' I.STEEL 4xiHSROLASS <br /> Ia.I 10TOPLASTIC1 <br /> .N016 9A OTNent[SDadrF) <br /> 3. IT ...k.LONBKTINSTALLIiD . USDIClT 3TRPHt PLA I.CONTNME75VM <br /> YU.UNDER DISPEN36R _ONT:_N T <br /> co sraucnoNTYPE ❑ 1.AnICLE wnL1 Q P.DOClp1$wAu <br /> C U nGNM.ITERIAL ❑ -NO OISPAiSSRS 90.NONE oma <br /> I STPEI Q FIRXRGLAE 1 WOIDP A 91.OTf1ER w csea <br /> CORROS7ONP T&CT[�i1@ . <br /> STEPL(Sl.IINPVEN7'PR0TP.CTTON EJ LSA Qill?wil3®tSIRRENT <br /> ❑ d.ISOWTION .... <br /> VL APPIACANrairrNATU <br /> CERTIFIC,AT30N: IeerlBfy that thq UST ryr/e!rt 11 COfilZ iR xtth the hdAArdOdAARhlgnee dtorrd Addtlul the in<e.mytlo„ <br /> dq M1Rm bmcoO ith Air drelRCRtb moulded hemi btrNe,eaRlakr <br /> APPLTCANTSIONATURE - DATB �j Alt <br /> APPLICANT NAM=(pririQ / / i Tl'O.B ,pr. <br /> UTGFUS['-B-IR <br /> Rev.II7IdOD'J) <br />